{"hospital_name":"Conway Medical Center","last_updated_on":"2026-01-01","version":"2.2.0","hospital_location":["Conway Medical Center"],"hospital_address":["300 Singleton Ridge Road, Conway, SC 29526"],"license_information":{"license_number":"HTL-0083","state":"SC"},"affirmation":{"affirmation":"To the best of its knowledge and belief, the 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 indicated.","confirm_affirmation":true},"financial_aid_policy":["60% off of facility standard gross charges."],"standard_charge_information":[{"description":"Lead Level Poc","code_information":[{"code":"1019771","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":7.6,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Lipid Profile Poc","code_information":[{"code":"1019804","type":"CDM"},{"code":"510","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.68,"discounted_cash":11.07,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Paring/Cutting Hypkeratotic Lesion, Single","code_information":[{"code":"1021773","type":"CDM"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.1,"discounted_cash":24.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Shave Epidermal Dermal Lesion Trunk Arms Legs 0.5Cm Or Less","code_information":[{"code":"1021788","type":"CDM"},{"code":"510","type":"RC"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":267.03,"discounted_cash":106.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":178.0,"discounted_cash":71.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Shave Epidermal Dermal Lesion Trunk Arms Legs 1.1 Cm  To 2.0 Cm","code_information":[{"code":"1021793","type":"CDM"},{"code":"510","type":"RC"},{"code":"11302","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.22,"discounted_cash":180.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":270.14,"discounted_cash":108.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":450.22,"discounted_cash":180.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Shave Epidermal Dermal Lesion Scalp Neck Hands Feet Genitals 0.5 Cm Or Less","code_information":[{"code":"1021796","type":"CDM"},{"code":"510","type":"RC"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Shave Epidermal Dermal Lesion Scalp Neck Hands Feet Genitals 0.6 Cm To 1.0 Cm","code_information":[{"code":"1021798","type":"CDM"},{"code":"510","type":"RC"},{"code":"11306","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.22,"discounted_cash":42.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":63.13,"discounted_cash":25.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Simple Repair, Face/Ears/Nose/Lips/Eyelids/Muc Membr,  2.6-5.0Cm 12013","code_information":[{"code":"1021854","type":"CDM"},{"code":"510","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Interm Repair,Face,Ears,Eyelids,Nose Lips, Muc Mem 2.5Cm Or Less","code_information":[{"code":"1021859","type":"CDM"},{"code":"510","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.25,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":776.25,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Intermediate Repair, Scalp/Axillae/Trunk/Extem, 7.6-12.5Cm","code_information":[{"code":"1021861","type":"CDM"},{"code":"510","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.6,"discounted_cash":314.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":471.96,"discounted_cash":188.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":786.6,"discounted_cash":314.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Intermediate Repair, Neck/Hands/Feet/Genital, 2.5Cm Or Less 12041","code_information":[{"code":"1021864","type":"CDM"},{"code":"510","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.42,"discounted_cash":312.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":468.86,"discounted_cash":187.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":313.0,"discounted_cash":125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":781.42,"discounted_cash":312.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Single Tendon Sheath Ligament Aponeurosis Injection","code_information":[{"code":"1021899","type":"CDM"},{"code":"510","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1292.0,"discounted_cash":516.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Puncture Aspiraton, Breast, Cyst; 1St 19000","code_information":[{"code":"1021904","type":"CDM"},{"code":"510","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":844.56,"discounted_cash":337.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":563.0,"discounted_cash":225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":89.36,"discounted_cash":35.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Destruction 2-14 Lesions 17003","code_information":[{"code":"1021907","type":"CDM"},{"code":"510","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":11.38,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":18.96,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Destruction Single Lesion 17000","code_information":[{"code":"1021908","type":"CDM"},{"code":"510","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":267.03,"discounted_cash":106.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":178.0,"discounted_cash":71.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Intermediate Repair, Face/Ears/Eyelid/Nose/Lip/Muc Memb, 5.1-7.5Cm 12053","code_information":[{"code":"1021913","type":"CDM"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.31,"discounted_cash":174.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Intermediate Repair Wounds; Face Ears Eyelids Nose Lips 2.6-5.0Cm 12052","code_information":[{"code":"1021914","type":"CDM"},{"code":"510","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.6,"discounted_cash":314.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":471.96,"discounted_cash":188.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":786.6,"discounted_cash":314.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Comp Preventive Med Less Than 1 Year New 99381","code_information":[{"code":"1025763","type":"CDM"},{"code":"510","type":"RC"},{"code":"99381","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":186.3,"discounted_cash":74.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Comp Preventive Med 18 To 39 Years New 99385","code_information":[{"code":"1025766","type":"CDM"},{"code":"510","type":"RC"},{"code":"99385","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":127.0,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":212.18,"discounted_cash":84.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Comp Preventive Med 40 To 64 Years New 99386","code_information":[{"code":"1025767","type":"CDM"},{"code":"510","type":"RC"},{"code":"99386","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":248.4,"discounted_cash":99.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Comp Preventive Med 5 To 11 Years New 99383","code_information":[{"code":"1025768","type":"CDM"},{"code":"510","type":"RC"},{"code":"99383","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":81.0,"discounted_cash":32.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":201.82,"discounted_cash":80.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Periodic Comp Preventive Med Less Than 1 Year Est 99391","code_information":[{"code":"1025770","type":"CDM"},{"code":"510","type":"RC"},{"code":"99391","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":87.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":58.0,"discounted_cash":23.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":144.9,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Periodic Comp Preventive Med 12 To 17 Years Est 99394","code_information":[{"code":"1025771","type":"CDM"},{"code":"99394","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":70.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":175.95,"discounted_cash":70.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Periodic Comp Preventive Med 1 To 4 Years Est 99392","code_information":[{"code":"1025772","type":"CDM"},{"code":"510","type":"RC"},{"code":"99392","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":93.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":155.25,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Periodic Comp Preventive Med 18 To 39 Years Est 99395","code_information":[{"code":"1025773","type":"CDM"},{"code":"99395","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":181.12,"discounted_cash":72.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Periodic Comp Preventive Med 40 To 64 Years Est 99396","code_information":[{"code":"1025774","type":"CDM"},{"code":"99396","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":191.48,"discounted_cash":76.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Periodic Comp Preventive Med 5 To 11 Years Est 99393","code_information":[{"code":"1025775","type":"CDM"},{"code":"510","type":"RC"},{"code":"99393","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":66.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":165.6,"discounted_cash":66.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Periodic Comp Preventive Med 65 Plus Years Est 99397","code_information":[{"code":"1025776","type":"CDM"},{"code":"99397","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":212.18,"discounted_cash":84.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 1 Est 99211","code_information":[{"code":"1025788","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":165.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":110.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":25.88,"discounted_cash":10.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 2 Est 99212","code_information":[{"code":"1027764","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":167.0,"discounted_cash":66.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":111.0,"discounted_cash":44.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":85.56,"discounted_cash":34.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 2 New 99202","code_information":[{"code":"1027765","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":100.71,"discounted_cash":40.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 3 Est 99213","code_information":[{"code":"1027766","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":102.49,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 3 New 99203","code_information":[{"code":"1027767","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":178.2,"discounted_cash":71.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":154.3,"discounted_cash":61.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 4 Est 99214","code_information":[{"code":"1027768","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.25,"discounted_cash":124.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":186.15,"discounted_cash":74.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":158.27,"discounted_cash":63.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 4 New 99204","code_information":[{"code":"1027769","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":192.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":261.65,"discounted_cash":104.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 5 Est 99215","code_information":[{"code":"1027770","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.58,"discounted_cash":131.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":197.15,"discounted_cash":78.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":224.47,"discounted_cash":89.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Visit Level 5 New 99205","code_information":[{"code":"1027771","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":207.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":340.08,"discounted_cash":136.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Consult Level 1 99241","code_information":[{"code":"1027780","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":124.2,"discounted_cash":49.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Consult Level 2 99242","code_information":[{"code":"1027781","type":"CDM"},{"code":"510","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":82.0,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":137.2,"discounted_cash":54.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Consult Level 3 99243","code_information":[{"code":"1027782","type":"CDM"},{"code":"510","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":191.35,"discounted_cash":76.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Consult Level 4 99244","code_information":[{"code":"1027783","type":"CDM"},{"code":"510","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":183.0,"discounted_cash":73.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":122.0,"discounted_cash":48.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":304.52,"discounted_cash":121.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Office Consult Level 5 99245","code_information":[{"code":"1027784","type":"CDM"},{"code":"510","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":228.0,"discounted_cash":91.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":152.0,"discounted_cash":60.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":379.76,"discounted_cash":151.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Continuous Aerosol Each Addl Hour Charge","code_information":[{"code":"1058045","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Continuous Aerosol 1St Hour Charge","code_information":[{"code":"1058046","type":"CDM"},{"code":"410","type":"RC"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aerosol Inhalation Pentamindine Charge","code_information":[{"code":"1058047","type":"CDM"},{"code":"410","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Initial Comp Preventive Med 12 To 17 Years New 99384","code_information":[{"code":"1065765","type":"CDM"},{"code":"510","type":"RC"},{"code":"99384","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":207.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Comp Preventive Med 1 To 4 Years New 99382","code_information":[{"code":"1065766","type":"CDM"},{"code":"510","type":"RC"},{"code":"99382","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":78.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":196.65,"discounted_cash":78.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Hearing Screen Poc","code_information":[{"code":"1083772","type":"CDM"},{"code":"92551","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Influenza Poc","code_information":[{"code":"1083775","type":"CDM"},{"code":"300","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.87,"discounted_cash":13.55,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":34.0,"discounted_cash":13.6,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Rsv Poc","code_information":[{"code":"1083784","type":"CDM"},{"code":"300","type":"RC"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.82,"discounted_cash":21.53,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Urinalysis Dipstick Poc","code_information":[{"code":"1083787","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":9.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Vision Testing Poc","code_information":[{"code":"1083789","type":"CDM"},{"code":"510","type":"RC"},{"code":"99177","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hemoglobin A1C Poc","code_information":[{"code":"1109763","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Fetal Fibronectin","code_information":[{"code":"1147772","type":"CDM"},{"code":"300","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urinalysis With Microscopic, If Indicated","code_information":[{"code":"1148022","type":"CDM"},{"code":"300","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hdl Cholesterol","code_information":[{"code":"1148243","type":"CDM"},{"code":"300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Triglycerides","code_information":[{"code":"1148252","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Total Volume Potassium","code_information":[{"code":"1148263","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Total Volume Protein","code_information":[{"code":"1148274","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Total Volume Sodium","code_information":[{"code":"1148300","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bd Bone Density Dexa App Skeleton","code_information":[{"code":"1167837","type":"CDM"},{"code":"320","type":"RC"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bd Bone Density Dexa Axial Skeleton","code_information":[{"code":"1167839","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abdomen W/ + W/O Contrast","code_information":[{"code":"1167845","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":3695.0,"discounted_cash":1478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abdomen W/ Contrast","code_information":[{"code":"1167847","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":1282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abdomen W/O Contrast","code_information":[{"code":"1167849","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Abdomen Aorta + Iliofemoral","code_information":[{"code":"1167851","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":2673.0,"discounted_cash":1069.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Abdomen","code_information":[{"code":"1167853","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":2673.0,"discounted_cash":1069.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Brain/Head","code_information":[{"code":"1167871","type":"CDM"},{"code":"351","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.0,"discounted_cash":788.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Neck","code_information":[{"code":"1167879","type":"CDM"},{"code":"350","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.0,"discounted_cash":808.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Pelvis","code_information":[{"code":"1167881","type":"CDM"},{"code":"352","type":"RC"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":2324.0,"discounted_cash":929.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Bone Superficial","code_information":[{"code":"1167917","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Liver","code_information":[{"code":"1167919","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Lung/Mediastinum","code_information":[{"code":"1167921","type":"CDM"},{"code":"350","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":4432.0,"discounted_cash":1772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Pancreas","code_information":[{"code":"1167925","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Pleura","code_information":[{"code":"1167927","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Renal","code_information":[{"code":"1167931","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Cerebral Perfusion Study","code_information":[{"code":"1167955","type":"CDM"},{"code":"359","type":"RC"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":2788.0,"discounted_cash":1115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Guidance Marking Radiation Therapy","code_information":[{"code":"1168062","type":"CDM"},{"code":"350","type":"RC"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":238.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Brain/Head W/ + W/O Contrast","code_information":[{"code":"1168090","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2794.0,"discounted_cash":1117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Brain/Head W/ Contrast","code_information":[{"code":"1168092","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2349.0,"discounted_cash":939.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Brain/Head W/O Contrast","code_information":[{"code":"1168094","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Lower Extremity W/ Contrast Bilat","code_information":[{"code":"1168164","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":4626.0,"discounted_cash":1850.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Ct Lower Extremity W/ Contrast Left","code_information":[{"code":"1168166","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":925.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Ct Lower Extremity W/ Contrast Right","code_information":[{"code":"1168168","type":"CDM"},{"code":"350","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":925.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Ct Lower Extremity W/+W/O Contrast Bilat","code_information":[{"code":"1168170","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":518.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Ct Lower Extremity W/+W/O Contrast Left","code_information":[{"code":"1168172","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":518.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Ct Lower Extremity W/+W/O Contrast Right","code_information":[{"code":"1168174","type":"CDM"},{"code":"350","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":518.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Ct Lower Extremity W/O Contrast Bilat","code_information":[{"code":"1168176","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":4502.0,"discounted_cash":1800.8,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Ct Lower Extremity W/O Contrast Left","code_information":[{"code":"1168178","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2251.0,"discounted_cash":900.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Ct Lower Extremity W/O Contrast Right","code_information":[{"code":"1168180","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2251.0,"discounted_cash":900.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Ct Maxillofacial W/ + W/O Contrast","code_information":[{"code":"1168182","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Maxillofacial W/ Contrast","code_information":[{"code":"1168184","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Maxillofacial W/O Contrast","code_information":[{"code":"1168186","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Orbits Sella W/ + W/O Contrast","code_information":[{"code":"1168188","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.0,"discounted_cash":857.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Orbits Sella W/ Contrast","code_information":[{"code":"1168190","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Orbits Sella W/O Contrast","code_information":[{"code":"1168192","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":777.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Pelvis W/ + W/O Contrast","code_information":[{"code":"1168194","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":3686.0,"discounted_cash":1474.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Pelvis W/ Contrast","code_information":[{"code":"1168196","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":1282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Pelvis W/O Contrast","code_information":[{"code":"1168198","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Sinus W/O Contrast","code_information":[{"code":"1168228","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Neck Soft Tissue W/ + W/O Contrast","code_information":[{"code":"1168230","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":2424.0,"discounted_cash":969.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Neck Soft Tissue W/ Contrast","code_information":[{"code":"1168232","type":"CDM"},{"code":"351","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Neck Soft Tissue W/O Contrast","code_information":[{"code":"1168234","type":"CDM"},{"code":"351","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2095.0,"discounted_cash":838.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Cervical W/ + W/O Contrast","code_information":[{"code":"1168236","type":"CDM"},{"code":"352","type":"RC"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Cervical W/ Contrast","code_information":[{"code":"1168238","type":"CDM"},{"code":"352","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Cervical W/O Contrast","code_information":[{"code":"1168240","type":"CDM"},{"code":"352","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1987.0,"discounted_cash":794.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Lumbar W/ + W/O Contrast","code_information":[{"code":"1168242","type":"CDM"},{"code":"352","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2976.0,"discounted_cash":1190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Lumbar W/ Contrast","code_information":[{"code":"1168244","type":"CDM"},{"code":"352","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2585.0,"discounted_cash":1034.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Lumbar W/O Contrast","code_information":[{"code":"1168246","type":"CDM"},{"code":"352","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2796.0,"discounted_cash":1118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Thoracic W/ + W/O Contrast","code_information":[{"code":"1168248","type":"CDM"},{"code":"352","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":2976.0,"discounted_cash":1190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Thoracic W/ Contrast","code_information":[{"code":"1168250","type":"CDM"},{"code":"352","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":2585.0,"discounted_cash":1034.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Spine Thoracic W/O Contrast","code_information":[{"code":"1168252","type":"CDM"},{"code":"352","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Thorax W/ + W/O Contrast","code_information":[{"code":"1168283","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3695.0,"discounted_cash":1478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Thorax W/ Contrast","code_information":[{"code":"1168285","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3077.0,"discounted_cash":1230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Thorax W/O Contrast","code_information":[{"code":"1168287","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Misc","code_information":[{"code":"1168307","type":"CDM"},{"code":"352","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.0,"discounted_cash":598.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Upper Extremity W/ Contrast Left","code_information":[{"code":"1168311","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":5664.0,"discounted_cash":2265.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Ct Upper Extremity W/ Contrast Right","code_information":[{"code":"1168313","type":"CDM"},{"code":"350","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":5664.0,"discounted_cash":2265.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Ct Upper Extremity W/+W/O Contrast Left","code_information":[{"code":"1168317","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":5948.0,"discounted_cash":2379.2,"setting":"both","modifiers":"52|LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Ct Upper Extremity W/+W/O Contrast Right","code_information":[{"code":"1168319","type":"CDM"},{"code":"350","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":5948.0,"discounted_cash":2379.2,"setting":"both","modifiers":"52|RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Ct Upper Extremity W/O Contrast Left","code_information":[{"code":"1168323","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":2232.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Ct Upper Extremity W/O Contrast Right","code_information":[{"code":"1168325","type":"CDM"},{"code":"350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":2232.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mra Abdomen W/ + W/O Contrast","code_information":[{"code":"1168635","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1439.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Abdomen W/O Contrast","code_information":[{"code":"1168639","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3599.0,"discounted_cash":1439.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Chest W/ + W/O Contrast","code_information":[{"code":"1168643","type":"CDM"},{"code":"618","type":"RC"},{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"gross_charge":2964.0,"discounted_cash":1185.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Brain/Head W/O Contrast","code_information":[{"code":"1168653","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3334.0,"discounted_cash":1333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Lower Extremity W/ + W/O Cnt Right","code_information":[{"code":"1168665","type":"CDM"},{"code":"618","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4149.0,"discounted_cash":1659.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mra Neck W/ + W/O Contrast","code_information":[{"code":"1168679","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":3063.0,"discounted_cash":1225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Neck W/O Contrast","code_information":[{"code":"1168683","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":2955.0,"discounted_cash":1182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Pelvis W/ + W/O Contrast","code_information":[{"code":"1168687","type":"CDM"},{"code":"618","type":"RC"},{"code":"C8918","type":"HCPCS"}],"standard_charges":[{"gross_charge":2964.0,"discounted_cash":1185.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Abdomen W/ + W/O Contrast","code_information":[{"code":"1168730","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":5174.0,"discounted_cash":2069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Abdomen W/ Contrast","code_information":[{"code":"1168732","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":3674.0,"discounted_cash":1469.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Abdomen W/O Contrast","code_information":[{"code":"1168734","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Brain W/ + W/O Contrast","code_information":[{"code":"1168796","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":5060.0,"discounted_cash":2024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Brain W/ Contrast","code_information":[{"code":"1168798","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":1437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Brain W/O Contrast","code_information":[{"code":"1168800","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":4081.0,"discounted_cash":1632.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Breast W/ + W/O Contrast Bilateral","code_information":[{"code":"1168802","type":"CDM"},{"code":"610","type":"RC"},{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.0,"discounted_cash":729.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Breast W/O Contrast Bilateral","code_information":[{"code":"1168814","type":"CDM"},{"code":"610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1820.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Chest W/ + W/O Contrast","code_information":[{"code":"1168820","type":"CDM"},{"code":"610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5174.0,"discounted_cash":2069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Chest W/ Contrast","code_information":[{"code":"1168822","type":"CDM"},{"code":"610","type":"RC"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3674.0,"discounted_cash":1469.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Chest W/O Contrast","code_information":[{"code":"1168824","type":"CDM"},{"code":"610","type":"RC"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Face Neck Orbit W/ Contrast","code_information":[{"code":"1168854","type":"CDM"},{"code":"611","type":"RC"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":1437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Face Neck Orbit W/O Contrast","code_information":[{"code":"1168856","type":"CDM"},{"code":"610","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":4081.0,"discounted_cash":1632.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Lower Ext W/ + W/O Contrast Left","code_information":[{"code":"1169008","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":4771.0,"discounted_cash":1908.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mri Lower Extremity W/ + W/O Cnt Right","code_information":[{"code":"1169010","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":4771.0,"discounted_cash":1908.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mri Lower Extremity W/ Contrast Left","code_information":[{"code":"1169014","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":3674.0,"discounted_cash":1469.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mri Lower Extremity W/ Contrast Right","code_information":[{"code":"1169016","type":"CDM"},{"code":"610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":3674.0,"discounted_cash":1469.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mri Lower Extremity W/O Contrast Left","code_information":[{"code":"1169020","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":4222.0,"discounted_cash":1688.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mri Lower Extremity W/O Contrast Right","code_information":[{"code":"1169022","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":4222.0,"discounted_cash":1688.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mri Pelvis W/ + W/O Contrast","code_information":[{"code":"1169024","type":"CDM"},{"code":"612","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":4658.0,"discounted_cash":1863.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Pelvis W/ Contrast","code_information":[{"code":"1169026","type":"CDM"},{"code":"612","type":"RC"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.0,"discounted_cash":545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Pelvis W/O Contrast","code_information":[{"code":"1169028","type":"CDM"},{"code":"612","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":3409.0,"discounted_cash":1363.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Cervical W/ + W/O Contrast","code_information":[{"code":"1169050","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":5060.0,"discounted_cash":2024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Cervical W/ Contrast","code_information":[{"code":"1169052","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":1437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Cervical W/O Contrast","code_information":[{"code":"1169054","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":4081.0,"discounted_cash":1632.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Lumbar W/ + W/O Contrast","code_information":[{"code":"1169056","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":5174.0,"discounted_cash":2069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Lumbar W/ Contrast","code_information":[{"code":"1169058","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":3674.0,"discounted_cash":1469.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Lumbar W/O Contrast","code_information":[{"code":"1169060","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Thoracic W/ + W/O Contrast","code_information":[{"code":"1169062","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":5060.0,"discounted_cash":2024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Thoracic W/ Contrast","code_information":[{"code":"1169064","type":"CDM"},{"code":"612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":1437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Thoracic W/O Contrast","code_information":[{"code":"1169066","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Tmj","code_information":[{"code":"1169068","type":"CDM"},{"code":"610","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Upper Extremity W/ + W/O Cnt Left","code_information":[{"code":"1169108","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5174.0,"discounted_cash":2069.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mri Upper Extremity W/ + W/O Cnt Right","code_information":[{"code":"1169110","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5174.0,"discounted_cash":2069.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mri Upper Extremity W/ Contrast Left","code_information":[{"code":"1169114","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":4222.0,"discounted_cash":1688.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mri Upper Extremity W/ Contrast Right","code_information":[{"code":"1169116","type":"CDM"},{"code":"610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":4222.0,"discounted_cash":1688.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mri Upper Extremity W/O Contrast Left","code_information":[{"code":"1169120","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":4222.0,"discounted_cash":1688.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mri Upper Extremity W/O Contrast Right","code_information":[{"code":"1169122","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":4222.0,"discounted_cash":1688.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Nm Inflamation Loc Spect","code_information":[{"code":"1169158","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":651.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Bone Imaging Limited Injection","code_information":[{"code":"1169176","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":558.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Bone Spect","code_information":[{"code":"1169188","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":4114.0,"discounted_cash":1645.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Bone Three Phase Study","code_information":[{"code":"1169190","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":558.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Brain Imaging Vascular Flow Only","code_information":[{"code":"1169200","type":"CDM"},{"code":"341","type":"RC"},{"code":"78606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2400.0,"discounted_cash":960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Brain Spect","code_information":[{"code":"1169202","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":651.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Cardiac Muga","code_information":[{"code":"1169208","type":"CDM"},{"code":"341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Cisternography","code_information":[{"code":"1169226","type":"CDM"},{"code":"341","type":"RC"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":3120.0,"discounted_cash":1248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Gastric Emptying Study","code_information":[{"code":"1169236","type":"CDM"},{"code":"341","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":695.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Gastrointestinal Blood Loss Imaging","code_information":[{"code":"1169242","type":"CDM"},{"code":"341","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.0,"discounted_cash":405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Intestine Imaging Meckels","code_information":[{"code":"1169254","type":"CDM"},{"code":"341","type":"RC"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Kidney Imaging Single W/ Pharm","code_information":[{"code":"1169262","type":"CDM"},{"code":"341","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":1870.0,"discounted_cash":748.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Kidney Spect","code_information":[{"code":"1169270","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":651.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Liver Imaging Spect","code_information":[{"code":"1169278","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":651.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Liver/Spleen Imaging","code_information":[{"code":"1169286","type":"CDM"},{"code":"341","type":"RC"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.0,"discounted_cash":405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Lymphoscintigraphy","code_information":[{"code":"1169292","type":"CDM"},{"code":"341","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2990.0,"discounted_cash":1196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Parathyroid Imaging Injection","code_information":[{"code":"1169316","type":"CDM"},{"code":"341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":500.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Lung Perfusion Imaging","code_information":[{"code":"1169328","type":"CDM"},{"code":"341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":402.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Thyroid Cancer Imaging Whole Body","code_information":[{"code":"1169386","type":"CDM"},{"code":"341","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":680.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Tumor Loc Spect","code_information":[{"code":"1169408","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":651.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pet Brain Imaging Metabolic Evaluation","code_information":[{"code":"1169442","type":"CDM"},{"code":"404","type":"RC"},{"code":"78608","type":"HCPCS"}],"standard_charges":[{"gross_charge":5983.0,"discounted_cash":2393.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pet Ct Limited Area","code_information":[{"code":"1169556","type":"CDM"},{"code":"404","type":"RC"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.0,"discounted_cash":2702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pet Ct Skull Base To Midthigh","code_information":[{"code":"1169558","type":"CDM"},{"code":"404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.0,"discounted_cash":2702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pet Ct Whole Body","code_information":[{"code":"1169560","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.0,"discounted_cash":2702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Abdomen Complete","code_information":[{"code":"1169567","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1588.0,"discounted_cash":635.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Abdomen Limited","code_information":[{"code":"1169569","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Breast Biopsy W/ Us Guide Left","code_information":[{"code":"1169595","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3729.0,"discounted_cash":1491.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Breast Biopsy W/ Us Guide Right","code_information":[{"code":"1169597","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3729.0,"discounted_cash":1491.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Biopsy Liver","code_information":[{"code":"1169599","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Biopsy Renal Left","code_information":[{"code":"1169615","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Biopsy Renal Right","code_information":[{"code":"1169617","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Carotid Duplex Bilateral","code_information":[{"code":"1169631","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":624.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Chest","code_information":[{"code":"1169635","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Fetal Biophysical Profile W/O N-Str","code_information":[{"code":"1169689","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Amniocentesis","code_information":[{"code":"1169707","type":"CDM"},{"code":"402","type":"RC"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Intraoperative","code_information":[{"code":"1169717","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Head/Neck Soft Tissue","code_information":[{"code":"1169729","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Kidney Transplant W/ Doppler","code_information":[{"code":"1169749","type":"CDM"},{"code":"320","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Lower Ext Arterial Duplex Bilateral","code_information":[{"code":"1169759","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Lower Ext Arterial Duplex Left","code_information":[{"code":"1169761","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.0,"discounted_cash":585.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Lower Ext Arterial Duplex Right","code_information":[{"code":"1169763","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.0,"discounted_cash":585.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Lower Ext Venous Duplex Bilateral","code_information":[{"code":"1169769","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Lower Ext Venous Duplex Left","code_information":[{"code":"1169771","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.0,"discounted_cash":707.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Lower Ext Venous Duplex Right","code_information":[{"code":"1169773","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.0,"discounted_cash":707.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Paracentesis","code_information":[{"code":"1169838","type":"CDM"},{"code":"320","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":1100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Ob Less Thn 14 Wks W/Tvs If Indicated","code_information":[{"code":"1169848","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":471.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Ob Greater Than 14 Weeks","code_information":[{"code":"1169850","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":471.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Ob Follow Up","code_information":[{"code":"1169854","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Ob Limited","code_information":[{"code":"1169856","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Ob Transvaginal","code_information":[{"code":"1169861","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Scrotum (Contents) W/ Doppler If Ind","code_information":[{"code":"1169877","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Spinal Canal","code_information":[{"code":"1169879","type":"CDM"},{"code":"402","type":"RC"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1475.0,"discounted_cash":590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Thoracentesis","code_information":[{"code":"1169881","type":"CDM"},{"code":"360","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":704.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Transvaginal Non-Ob","code_information":[{"code":"1169889","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Upper Ext Arterial Duplex Bilateral","code_information":[{"code":"1169895","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Upper Ext Arterial Duplex Left","code_information":[{"code":"1169897","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1463.0,"discounted_cash":585.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Upper Ext Arterial Duplex Right","code_information":[{"code":"1169899","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":842.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Upper Ext Venous Duplex Bilateral","code_information":[{"code":"1169901","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Upper Ext Venous Duplex Left","code_information":[{"code":"1169903","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.0,"discounted_cash":707.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Upper Ext Venous Duplex Right","code_information":[{"code":"1169905","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.0,"discounted_cash":707.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Ac Joints Bilateral","code_information":[{"code":"1169922","type":"CDM"},{"code":"320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.43,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":46.43,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Abdomen Kub 1 View","code_information":[{"code":"1169926","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.55,"discounted_cash":17.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":26.85,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Abdomen Series + Chest 1 View","code_information":[{"code":"1169932","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.99,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":423.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":53.99,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Ankle 2 Views Bilateral","code_information":[{"code":"1169934","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.45,"discounted_cash":16.18,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":736.0,"discounted_cash":294.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":40.45,"discounted_cash":16.18,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Ankle 2 Views Left","code_information":[{"code":"1169936","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":20.92,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":52.31,"discounted_cash":20.92,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Ankle 2 Views Right","code_information":[{"code":"1169938","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.45,"discounted_cash":16.18,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":40.45,"discounted_cash":16.18,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Ankle Complete 3+ Views Left","code_information":[{"code":"1169942","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.71,"discounted_cash":16.68,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":41.71,"discounted_cash":16.68,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Ankle Complete 3+ Views Right","code_information":[{"code":"1169944","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.71,"discounted_cash":16.68,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":41.71,"discounted_cash":16.68,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Barium Enema Complete","code_information":[{"code":"1170002","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":234.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Barium Enema W/ Air Complete","code_information":[{"code":"1170006","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":247.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Bone Age Studies","code_information":[{"code":"1170014","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Bone Length Studies Scanograms","code_information":[{"code":"1170016","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Osseous Survey Complete","code_information":[{"code":"1170018","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Osseous Survey Infant","code_information":[{"code":"1170020","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.01,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":117.01,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Osseous Survey Limited","code_information":[{"code":"1170022","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.06,"discounted_cash":31.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":642.0,"discounted_cash":256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":79.06,"discounted_cash":31.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Calcaneus Left","code_information":[{"code":"1170032","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Calcaneus Right","code_information":[{"code":"1170034","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Chest 1 View Frontal","code_information":[{"code":"1170038","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Chest 2 Views W/ Apical Lordotic","code_information":[{"code":"1170040","type":"CDM"},{"code":"324","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.41,"discounted_cash":15.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":38.41,"discounted_cash":15.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Chest 2 Views W/ Obliques","code_information":[{"code":"1170044","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.22,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":47.22,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Chest Decubitus","code_information":[{"code":"1170049","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":292.0,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Chest 4+ Views","code_information":[{"code":"1170053","type":"CDM"},{"code":"324","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.25,"discounted_cash":19.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":49.25,"discounted_cash":19.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Cholangiogram In Or","code_information":[{"code":"1170065","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Clavicle Left","code_information":[{"code":"1170075","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.68,"discounted_cash":14.27,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":35.68,"discounted_cash":14.27,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Clavicle Right","code_information":[{"code":"1170077","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.68,"discounted_cash":14.27,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":35.68,"discounted_cash":14.27,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Elbow 2 Views Bilateral","code_information":[{"code":"1170119","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":736.0,"discounted_cash":294.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Elbow 2 Views Left","code_information":[{"code":"1170121","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Elbow 2 Views Right","code_information":[{"code":"1170123","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Elbow Complete 3+ Views Left","code_information":[{"code":"1170127","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.91,"discounted_cash":16.76,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":41.91,"discounted_cash":16.76,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Elbow Complete 3+ Views Right","code_information":[{"code":"1170129","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.91,"discounted_cash":16.76,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":41.91,"discounted_cash":16.76,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Esophagus","code_information":[{"code":"1170137","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Facial Bones 3+ Views","code_information":[{"code":"1170141","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":491.0,"discounted_cash":196.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Femur Left","code_information":[{"code":"1170147","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Femur Right","code_information":[{"code":"1170149","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Finger(S) 2+ Views Left","code_information":[{"code":"1170151","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.18,"discounted_cash":18.07,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":45.18,"discounted_cash":18.07,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Finger(S) 2+ Views Right","code_information":[{"code":"1170153","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.18,"discounted_cash":18.07,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":45.18,"discounted_cash":18.07,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Fluoro Guidance Needle Placement","code_information":[{"code":"1170175","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Foot 2 Views Bilateral","code_information":[{"code":"1170183","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":19.84,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":736.0,"discounted_cash":294.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":49.6,"discounted_cash":19.84,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Foot 2 Views Left","code_information":[{"code":"1170185","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":19.84,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":49.6,"discounted_cash":19.84,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Foot 2 Views Right","code_information":[{"code":"1170187","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":19.84,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":49.6,"discounted_cash":19.84,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Foot Complete 3+ Views Left","code_information":[{"code":"1170191","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.34,"discounted_cash":15.34,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":38.34,"discounted_cash":15.34,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Foot Complete 3+ Views Right","code_information":[{"code":"1170193","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.34,"discounted_cash":15.34,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":38.34,"discounted_cash":15.34,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Forearm 2 Views Left","code_information":[{"code":"1170197","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":12.9,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":32.25,"discounted_cash":12.9,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Forearm 2 Views Right","code_information":[{"code":"1170199","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":12.9,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":32.25,"discounted_cash":12.9,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Foreign Body Localization Eye","code_information":[{"code":"1170203","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":35.62,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Foreign Body Localization Child 1 Vw","code_information":[{"code":"1170207","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":12.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":32.31,"discounted_cash":12.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Hand 2 Views Bilateral","code_information":[{"code":"1170213","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.56,"discounted_cash":40.22,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":101.0,"discounted_cash":40.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":975.0,"discounted_cash":390.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":50.28,"discounted_cash":20.11,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Hand 2 Views Left","code_information":[{"code":"1170215","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.28,"discounted_cash":20.11,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":50.28,"discounted_cash":20.11,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Hand 2 Views Right","code_information":[{"code":"1170217","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.28,"discounted_cash":20.11,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":50.28,"discounted_cash":20.11,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Hand Complete 3+ Views Left","code_information":[{"code":"1170221","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.8,"discounted_cash":16.72,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":41.8,"discounted_cash":16.72,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Hand Complete 3+ Views Right","code_information":[{"code":"1170223","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.8,"discounted_cash":16.72,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":41.8,"discounted_cash":16.72,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Hip 1 View Left","code_information":[{"code":"1170225","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.41,"discounted_cash":15.36,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":38.41,"discounted_cash":15.36,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Hip 1 View Right","code_information":[{"code":"1170227","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.41,"discounted_cash":15.36,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":38.41,"discounted_cash":15.36,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Hip Bilateral And Pelvis Adult 5 Vws","code_information":[{"code":"1170229","type":"CDM"},{"code":"320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.81,"discounted_cash":43.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":110.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":109.81,"discounted_cash":43.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Hip Complete 2+ Views Left","code_information":[{"code":"1170233","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":355.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Hip Complete 2+ Views Right","code_information":[{"code":"1170235","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.62,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":82.0,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":355.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":81.62,"discounted_cash":32.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Humerus Left","code_information":[{"code":"1170245","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.16,"discounted_cash":16.46,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":41.0,"discounted_cash":16.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Humerus Right","code_information":[{"code":"1170247","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Hysterosalpingography","code_information":[{"code":"1170249","type":"CDM"},{"code":"320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Ivp Limited","code_information":[{"code":"1170251","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Xr Knee 1 Or 2 Views Bilateral","code_information":[{"code":"1170261","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.78,"discounted_cash":27.91,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":736.0,"discounted_cash":294.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Knee 1 Or 2 Views Left","code_information":[{"code":"1170263","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.97,"discounted_cash":14.79,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Knee 1 Or 2 Views Right","code_information":[{"code":"1170265","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.97,"discounted_cash":14.79,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Knee 3 Views Left","code_information":[{"code":"1170269","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.26,"discounted_cash":11.3,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Knee 3 Views Right","code_information":[{"code":"1170271","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.26,"discounted_cash":11.3,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Knee 4 Views Bilateral","code_information":[{"code":"1170285","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":818.0,"discounted_cash":327.2,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Knee 4 Views Bilateral","code_information":[{"code":"1170286","type":"CDM"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Knee Complete 4+ Views Left","code_information":[{"code":"1170287","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":409.0,"discounted_cash":163.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Knee Complete 4+ Views Right","code_information":[{"code":"1170289","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":409.0,"discounted_cash":163.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Knee 1 View Standing Ap Bilateral","code_information":[{"code":"1170291","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.07,"discounted_cash":25.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":189.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":63.07,"discounted_cash":25.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Lower Extremity Infant (0-1Yr) Bilat","code_information":[{"code":"1170295","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":1088.0,"discounted_cash":435.2,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Lower Extremity Infant (0-1Yr) Left","code_information":[{"code":"1170297","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Lower Extremity Infant (0-1Yr) Right","code_information":[{"code":"1170299","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Mandible Complete 4+ Views","code_information":[{"code":"1170301","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":47.9,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Mandible Less Than 4 Views","code_information":[{"code":"1170303","type":"CDM"},{"code":"320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":120.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":63.3,"discounted_cash":25.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Mastoids Complete","code_information":[{"code":"1170315","type":"CDM"},{"code":"320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.93,"discounted_cash":28.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":424.0,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":70.93,"discounted_cash":28.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Myelogram Cervical Spine","code_information":[{"code":"1170319","type":"CDM"},{"code":"360","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":2333.0,"discounted_cash":933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Myelogram Lumbosacral Spine","code_information":[{"code":"1170321","type":"CDM"},{"code":"320","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2333.0,"discounted_cash":933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Myelogram Thoracic Spine","code_information":[{"code":"1170327","type":"CDM"},{"code":"320","type":"RC"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":2333.0,"discounted_cash":933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Nasal Bones 3+ Views","code_information":[{"code":"1170329","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.63,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":44.63,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Neck Soft Tissue","code_information":[{"code":"1170331","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":258.0,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Orbits Complete","code_information":[{"code":"1170339","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.31,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":53.31,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Pelvis 1 Or 2 Views","code_information":[{"code":"1170351","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":353.0,"discounted_cash":141.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Pelvis Complete 3+ Views","code_information":[{"code":"1170353","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.28,"discounted_cash":20.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":51.28,"discounted_cash":20.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Ribs 2 Views Left","code_information":[{"code":"1170371","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.19,"discounted_cash":18.08,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":45.19,"discounted_cash":18.08,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Ribs 2 Views Right","code_information":[{"code":"1170373","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.19,"discounted_cash":18.08,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":45.19,"discounted_cash":18.08,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Ribs 3 Views Bilateral","code_information":[{"code":"1170375","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.19,"discounted_cash":18.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":45.19,"discounted_cash":18.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Ribs W/ Pa Chest Bilateral","code_information":[{"code":"1170377","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.09,"discounted_cash":24.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":580.0,"discounted_cash":232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":60.09,"discounted_cash":24.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Sacroiliac Joints 3+ Views","code_information":[{"code":"1170387","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Sacrum/Coccyx 2+ Views","code_information":[{"code":"1170391","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.38,"discounted_cash":14.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":426.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":36.38,"discounted_cash":14.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Scapula Left","code_information":[{"code":"1170401","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.76,"discounted_cash":15.9,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":39.76,"discounted_cash":15.9,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Scapula Right","code_information":[{"code":"1170403","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.76,"discounted_cash":15.9,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":39.76,"discounted_cash":15.9,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Shoulder Complete 2+ Views Left","code_information":[{"code":"1170415","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Shoulder Complete 2+ Views Right","code_information":[{"code":"1170417","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Shuntogram Non-Vascular Si","code_information":[{"code":"1170428","type":"CDM"},{"code":"320","type":"RC"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Sinuses Paranasal < 3 Views","code_information":[{"code":"1170432","type":"CDM"},{"code":"320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":294.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Sinuses Paranasal Complete","code_information":[{"code":"1170434","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.22,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":47.22,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Skull < 4 Views","code_information":[{"code":"1170436","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Skull Complete","code_information":[{"code":"1170438","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.31,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":448.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":53.31,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Small Bowel W/ Multiple Series","code_information":[{"code":"1170442","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Spine Cervical 1 View","code_information":[{"code":"1170446","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":242.0,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":26.89,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Lumbar 1 View","code_information":[{"code":"1170448","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":242.0,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":26.89,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Thoracic 1 View","code_information":[{"code":"1170450","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":242.0,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":26.89,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Cervical 2 Or 3 Views","code_information":[{"code":"1170452","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.36,"discounted_cash":20.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":41.09,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Cervical 4 Or 5 Views","code_information":[{"code":"1170454","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.86,"discounted_cash":21.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":580.0,"discounted_cash":232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":53.86,"discounted_cash":21.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Cervical 6+ Views","code_information":[{"code":"1170461","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.61,"discounted_cash":28.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":678.0,"discounted_cash":271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":71.61,"discounted_cash":28.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Lumbosacral 2 Or 3 Views","code_information":[{"code":"1170470","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.72,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":43.72,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Lumbosacral Bending 2-3 Views","code_information":[{"code":"1170472","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.74,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":22.22,"discounted_cash":8.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":55.35,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Lumbosacral W/ Bending 6+ Views","code_information":[{"code":"1170474","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.52,"discounted_cash":34.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":86.52,"discounted_cash":34.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Lumbosacral 4+ Views","code_information":[{"code":"1170476","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.27,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":538.0,"discounted_cash":215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":61.27,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Scoliosis Study Standing","code_information":[{"code":"1170478","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Spine Thoracic 2 Views","code_information":[{"code":"1170484","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.97,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":427.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":36.97,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Thoracic 4+ Views","code_information":[{"code":"1170488","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.31,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":480.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":53.31,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Sternoclavicular Joint(S)","code_information":[{"code":"1170494","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.54,"discounted_cash":18.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":634.0,"discounted_cash":253.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":46.54,"discounted_cash":18.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Sternum 2+ Views","code_information":[{"code":"1170496","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Swallowing Function W/ Speech","code_information":[{"code":"1170500","type":"CDM"},{"code":"320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Tmj Open And Closed Bilateral","code_information":[{"code":"1170502","type":"CDM"},{"code":"320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.54,"discounted_cash":27.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":390.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":67.54,"discounted_cash":27.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Tibia/Fibula Left","code_information":[{"code":"1170516","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Tibia/Fibula Right","code_information":[{"code":"1170518","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Toe(S) 2+ Views Left","code_information":[{"code":"1170520","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.68,"discounted_cash":15.87,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":39.68,"discounted_cash":15.87,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Toe(S) 2+ Views Right","code_information":[{"code":"1170522","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.68,"discounted_cash":15.87,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":39.68,"discounted_cash":15.87,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Tomography Single Plane","code_information":[{"code":"1170546","type":"CDM"},{"code":"320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Upper Extremity Infant (0-1Yr) Left","code_information":[{"code":"1170558","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":443.0,"discounted_cash":177.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Upper Extremity Infant (0-1Yr) Right","code_information":[{"code":"1170560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":443.0,"discounted_cash":177.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Upper Gi","code_information":[{"code":"1170562","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Upper Gi W/ Air Contrast","code_information":[{"code":"1170566","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Upper Gi W/ Air W/ Small Bowel","code_information":[{"code":"1170570","type":"CDM"},{"code":"320","type":"RC"},{"code":"74249","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Upper Gi W/ Small Bowel","code_information":[{"code":"1170574","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.0,"discounted_cash":324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Wrist 2 Views Bilateral","code_information":[{"code":"1170604","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":28.12,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":768.0,"discounted_cash":307.2,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":56.24,"discounted_cash":22.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Wrist 2 Views Left","code_information":[{"code":"1170606","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":28.12,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.24,"discounted_cash":22.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Wrist 2 Views Right","code_information":[{"code":"1170608","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":28.12,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":56.24,"discounted_cash":22.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Wrist Complete 3+ Views Left","code_information":[{"code":"1170612","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Wrist Complete 3+ Views Right","code_information":[{"code":"1170614","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Fetal Stain","code_information":[{"code":"1173774","type":"CDM"},{"code":"300","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Inflammation Loc Limited","code_information":[{"code":"1226092","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":1282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Add'l 30 Min Increments Cc > 74","code_information":[{"code":"1235813","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":381.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Tip Culture","code_information":[{"code":"1277763","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Placenta Delivery Date/Time","code_information":[{"code":"1367235","type":"CDM"},{"code":"761","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":5580.0,"discounted_cash":2232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Metabolic Screening Date, Time Drawn","code_information":[{"code":"1370281","type":"CDM"},{"code":"300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Attended E-Stim Units","code_information":[{"code":"1373442","type":"CDM"},{"code":"430","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Iontophoresis Units","code_information":[{"code":"1373443","type":"CDM"},{"code":"430","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Manual Therapy Units","code_information":[{"code":"1373444","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Neuromuscular Reeducation Units","code_information":[{"code":"1373446","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Paraffin Bath Units","code_information":[{"code":"1373447","type":"CDM"},{"code":"430","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Ultrasound Units","code_information":[{"code":"1373448","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Therapeutic Exercise Units","code_information":[{"code":"1373449","type":"CDM"},{"code":"430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Therapeutic Activities Units","code_information":[{"code":"1373450","type":"CDM"},{"code":"948","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Group Therapy Units","code_information":[{"code":"1373451","type":"CDM"},{"code":"433","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":32.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Cognitive Skills Development Units","code_information":[{"code":"1373452","type":"CDM"},{"code":"430","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Re-Evaluation Units","code_information":[{"code":"1373548","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Otelectrical Stim (Unattended) - Non-Wound","code_information":[{"code":"1373552","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Whirlpool, Fluidotherapy Units","code_information":[{"code":"1373554","type":"CDM"},{"code":"430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":104.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Mmt, Extremity, Trunk Units","code_information":[{"code":"1373556","type":"CDM"},{"code":"430","type":"RC"},{"code":"95831","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Mmt, Hand Units","code_information":[{"code":"1373557","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Rom, Hand Units","code_information":[{"code":"1373561","type":"CDM"},{"code":"430","type":"RC"},{"code":"95852","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Contrast Bath Units","code_information":[{"code":"1373567","type":"CDM"},{"code":"430","type":"RC"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Sensory Integrative Techniques Units","code_information":[{"code":"1373568","type":"CDM"},{"code":"430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Self Care, Home Management Units","code_information":[{"code":"1373569","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Work Hardening-Initial 2 Hours Units","code_information":[{"code":"1373571","type":"CDM"},{"code":"420","type":"RC"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Work Hardening-Each Addl Hour Units","code_information":[{"code":"1373572","type":"CDM"},{"code":"420","type":"RC"},{"code":"97546","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Orthotic Management, Train Units","code_information":[{"code":"1373573","type":"CDM"},{"code":"430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":66.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Prosthetic Management, Train Units","code_information":[{"code":"1373575","type":"CDM"},{"code":"430","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":48.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Orthotic, Prosthetic Use, Check Out","code_information":[{"code":"1373668","type":"CDM"},{"code":"430","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Assistive Technology Eval Units","code_information":[{"code":"1373670","type":"CDM"},{"code":"430","type":"RC"},{"code":"97755","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Evaluation Units","code_information":[{"code":"1373673","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":125.6,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Slp Fluoroscopic Evaluation Units","code_information":[{"code":"1373839","type":"CDM"},{"code":"444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":124.4,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Auditory Processing Tx Units","code_information":[{"code":"1373841","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":49.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Swallow Dysfunction Oral Feed Units","code_information":[{"code":"1373842","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Pharyngeal Swallow Eval Units","code_information":[{"code":"1373843","type":"CDM"},{"code":"444","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":124.4,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Use,Fit Speech Prosthetic Eval Units","code_information":[{"code":"1373846","type":"CDM"},{"code":"440","type":"RC"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Assessment Of Aphasia Units","code_information":[{"code":"1373853","type":"CDM"},{"code":"440","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Speech Aac Eval Addl Half Hour Units","code_information":[{"code":"1373854","type":"CDM"},{"code":"443","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Pt Iontophoresis Units","code_information":[{"code":"1373909","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Manual Therapy Units","code_information":[{"code":"1373910","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Massage Units","code_information":[{"code":"1373911","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Mechanical Traction Units","code_information":[{"code":"1373912","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Neuromuscular Reeducation Units","code_information":[{"code":"1373913","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Paraffin Units","code_information":[{"code":"1373914","type":"CDM"},{"code":"420","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Reevaluation Units","code_information":[{"code":"1373915","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":85.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Sensory Integration Units","code_information":[{"code":"1373916","type":"CDM"},{"code":"430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Wheelchair Management Units","code_information":[{"code":"1373917","type":"CDM"},{"code":"420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Aquatic With Exercise Units","code_information":[{"code":"1373918","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":91.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Mobile Arm Support Left Units","code_information":[{"code":"1373938","type":"CDM"},{"code":"431","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Slp Cognitive Skills Development Units","code_information":[{"code":"1373954","type":"CDM"},{"code":"440","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Pt Assistive Technology Eval Units","code_information":[{"code":"1374008","type":"CDM"},{"code":"430","type":"RC"},{"code":"97755","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Contrast Bath Units","code_information":[{"code":"1374011","type":"CDM"},{"code":"420","type":"RC"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Gait Training Units","code_information":[{"code":"1374013","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Mmt Hand Units","code_information":[{"code":"1374014","type":"CDM"},{"code":"420","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Orthotic Prosthetic Check Out Units","code_information":[{"code":"1374015","type":"CDM"},{"code":"420","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Physical Performance Test","code_information":[{"code":"1374017","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Rigid Total Contact Leg Cast App Unit","code_information":[{"code":"1374018","type":"CDM"},{"code":"761","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Rom Measurement Hand Units","code_information":[{"code":"1374019","type":"CDM"},{"code":"420","type":"RC"},{"code":"95852","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Therapeutic Exercise Units","code_information":[{"code":"1374020","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Ultrasound Units","code_information":[{"code":"1374021","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Unattended E-Stim Units","code_information":[{"code":"1374022","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Work Hardening Initial 2 Hours Units","code_information":[{"code":"1374024","type":"CDM"},{"code":"420","type":"RC"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Therapeutic Activity Units","code_information":[{"code":"1374031","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Evaluation Units","code_information":[{"code":"1374035","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":125.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Biofeedback Units","code_information":[{"code":"1374113","type":"CDM"},{"code":"420","type":"RC"},{"code":"90901","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Mmt, Extremity, Trunk Units","code_information":[{"code":"1374114","type":"CDM"},{"code":"420","type":"RC"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Mmt, Total Body Exclude Hand Units","code_information":[{"code":"1374115","type":"CDM"},{"code":"420","type":"RC"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":104.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Community,Work Reintegration Units","code_information":[{"code":"1374118","type":"CDM"},{"code":"420","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Orthotic Management, Train Units","code_information":[{"code":"1374120","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":66.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Prosthetic Management, Train Units","code_information":[{"code":"1374121","type":"CDM"},{"code":"420","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":66.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Group Therapy Units","code_information":[{"code":"1374125","type":"CDM"},{"code":"423","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":37.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Strapping Knee Units","code_information":[{"code":"1374356","type":"CDM"},{"code":"420","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":80.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Strapping Toes Units","code_information":[{"code":"1374358","type":"CDM"},{"code":"420","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Level 4","code_information":[{"code":"1378484","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":120.34,"discounted_cash":48.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Level 1","code_information":[{"code":"1378485","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":94.66,"discounted_cash":37.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Level 2","code_information":[{"code":"1378486","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":137.93,"discounted_cash":55.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Level 3","code_information":[{"code":"1378487","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hemoglobin A1C (Glycosylated)","code_information":[{"code":"1383763","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"B-Type Natriuretic Peptide(Bnp)","code_information":[{"code":"1383771","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Acetaminophen Level","code_information":[{"code":"1503764","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":64.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alcohol Level","code_information":[{"code":"1503765","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Salicylate Level","code_information":[{"code":"1503768","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"99291 - Critical Care - Lynx Visit Level","code_information":[{"code":"1545764","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3222.0,"discounted_cash":1288.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"99285 - Level 5 - Lynx Visit Level","code_information":[{"code":"1545765","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"99284 - Level 4 - Lynx Visit Level","code_information":[{"code":"1545766","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.0,"discounted_cash":678.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"99283 - Level 3 - Lynx Visit Level","code_information":[{"code":"1545767","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"99282 - Level 2 - Lynx Visit Level","code_information":[{"code":"1545768","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":308.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"99281 - Level 1 - Lynx Visit Level","code_information":[{"code":"1545769","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Echocardiogram Transesophageal (Tee)","code_information":[{"code":"1606877","type":"CDM"},{"code":"480","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.0,"discounted_cash":1301.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Echocardiogram Stress","code_information":[{"code":"1606879","type":"CDM"},{"code":"480","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.14,"discounted_cash":210.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":2544.0,"discounted_cash":1017.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Albumin Level","code_information":[{"code":"1620877","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alkaline Phosphatase","code_information":[{"code":"1620878","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ammonia Level","code_information":[{"code":"1628880","type":"CDM"},{"code":"300","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Calcium Level","code_information":[{"code":"1628887","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C-Reactive Protein","code_information":[{"code":"1628890","type":"CDM"},{"code":"300","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Digoxin Level","code_information":[{"code":"1628891","type":"CDM"},{"code":"300","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ferritin","code_information":[{"code":"1628893","type":"CDM"},{"code":"300","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Folate Level","code_information":[{"code":"1628894","type":"CDM"},{"code":"300","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ggt","code_information":[{"code":"1628895","type":"CDM"},{"code":"300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose Level, Csf","code_information":[{"code":"1628897","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Haptoglobin-(502)","code_information":[{"code":"1628901","type":"CDM"},{"code":"300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis A Antibody, Igm-(512)","code_information":[{"code":"1628904","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis B Core Antibody, Igm-(4848)","code_information":[{"code":"1628907","type":"CDM"},{"code":"300","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis B Surface Antibody, Qual-(499)","code_information":[{"code":"1628908","type":"CDM"},{"code":"300","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein Cerebrospinal Fluid","code_information":[{"code":"1634881","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Psa, Diagnostic","code_information":[{"code":"1634882","type":"CDM"},{"code":"300","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Theophylline Level-(878)","code_information":[{"code":"1634886","type":"CDM"},{"code":"300","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tobramycin Level, Random","code_information":[{"code":"1634888","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tobramycin Level, Peak","code_information":[{"code":"1634889","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tobramycin Level, Trough","code_information":[{"code":"1634890","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Troponin-I","code_information":[{"code":"1634892","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatinine 24 Hour Urine","code_information":[{"code":"1634894","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vancomycin Level, Random","code_information":[{"code":"1634895","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vancomycin Level,  Peak","code_information":[{"code":"1634896","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vancomycin Level , Trough","code_information":[{"code":"1634897","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":178.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bili, Total","code_information":[{"code":"1635542","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bilirubin, Direct","code_information":[{"code":"1635543","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Total Volume Creatinine","code_information":[{"code":"1635558","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Monitored Anesthesia Care","code_information":[{"code":"1648924","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":28.21,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"General","code_information":[{"code":"1648930","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":16.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Moderate Sedation","code_information":[{"code":"1648936","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cervical Dilator Balloon 30 Cc Apply","code_information":[{"code":"1651368","type":"CDM"},{"code":"761","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.0,"discounted_cash":414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Collection: Venous Draw","code_information":[{"code":"1779389","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Collection: Venous Draw","code_information":[{"code":"1779400","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sedimentation Rate","code_information":[{"code":"1902793","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"U Creatinine","code_information":[{"code":"1930783","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lithium Level","code_information":[{"code":"2046348","type":"CDM"},{"code":"300","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Nursery Level 1","code_information":[{"code":"2120838","type":"CDM"},{"code":"171","type":"RC"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":465.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Icu","code_information":[{"code":"2120844","type":"CDM"},{"code":"200","type":"RC"}],"standard_charges":[{"gross_charge":2968.0,"discounted_cash":1187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Observation","code_information":[{"code":"2120846","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.3,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."},{"gross_charge":78.67,"discounted_cash":31.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Medical Obs Price Schedule"},{"gross_charge":92.58,"discounted_cash":37.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Monitored Obs Price Schedule"},{"gross_charge":114.86,"discounted_cash":45.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pcu Obs Price Schedule"}]},{"description":"Platelet Count","code_information":[{"code":"2182297","type":"CDM"},{"code":"300","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein, Total & Electrophoresis/Ref-(23036)","code_information":[{"code":"2248299","type":"CDM"},{"code":"300","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Last Hg A1C Level Less Than 7.0% 3044F","code_information":[{"code":"2388301","type":"CDM"},{"code":"3044F","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Immunization Admin Intranasal/Oral; 1 Vaccine 90473","code_information":[{"code":"2388333","type":"CDM"},{"code":"90473","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Immunization Admin Intranasal/Oral; Each Addtl Vaccine 90474","code_information":[{"code":"2388334","type":"CDM"},{"code":"90474","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Hepatitis B Vaccine, Ped/Adol (3 Dose), 90744","code_information":[{"code":"2388411","type":"CDM"},{"code":"510","type":"RC"},{"code":"90744","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.62,"discounted_cash":31.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":77.62,"discounted_cash":31.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Determination Of Refractive State 92015","code_information":[{"code":"2388502","type":"CDM"},{"code":"92015","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.03,"discounted_cash":16.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Otolaryngologic Exam Under General Anesthesia 92502","code_information":[{"code":"2388558","type":"CDM"},{"code":"92502","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.97,"discounted_cash":77.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Binoc Ear Microscopy Exam 92504","code_information":[{"code":"2388559","type":"CDM"},{"code":"92504","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.65,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tympanometry & Reflex Threshold 92550","code_information":[{"code":"2388581","type":"CDM"},{"code":"510","type":"RC"},{"code":"92550","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.72,"discounted_cash":138.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":208.04,"discounted_cash":83.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":139.0,"discounted_cash":55.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":346.72,"discounted_cash":138.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Pure Tone Threshold - Air And Bone 92553","code_information":[{"code":"2388584","type":"CDM"},{"code":"92553","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.4,"discounted_cash":28.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Speech Audiometry Threshold W/Speech Recognition 92556","code_information":[{"code":"2388586","type":"CDM"},{"code":"92556","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.08,"discounted_cash":28.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Acoustic Reflex Test Threshold 92568","code_information":[{"code":"2388597","type":"CDM"},{"code":"92568","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.93,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Stenger Test Speech 92577","code_information":[{"code":"2388603","type":"CDM"},{"code":"92577","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.39,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cardiopulmonary Resuscitation 92950","code_information":[{"code":"2388660","type":"CDM"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.55,"discounted_cash":153.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cardioversion Elective Arrhythmia External 92960","code_information":[{"code":"2388662","type":"CDM"},{"code":"510","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.12,"discounted_cash":99.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Rhythm Electrocardiogram (Ecg), 1-3 Leads, W/I&R (Global) 93040","code_information":[{"code":"2388687","type":"CDM"},{"code":"93040","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Program Device Eval In Person, Single Lead Icd Global 93282","code_information":[{"code":"2388704","type":"CDM"},{"code":"510","type":"RC"},{"code":"93282","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.89,"discounted_cash":56.76,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":85.13,"discounted_cash":34.05,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":86.77,"discounted_cash":34.71,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Interrogation Of Implant Loop Recorder Ilr In Person 93291","code_information":[{"code":"2388713","type":"CDM"},{"code":"93291","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.04,"discounted_cash":28.42,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":43.16,"discounted_cash":17.26,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Remote Interrogation 30-90 Days For Pacemaker Or Icd, Technical Review 93296","code_information":[{"code":"2388718","type":"CDM"},{"code":"510","type":"RC"},{"code":"93296","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.37,"discounted_cash":19.75,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Remote Interrogation Up To 30 Days For Ilr, Analysis And Ir 93298","code_information":[{"code":"2388720","type":"CDM"},{"code":"93298","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.84,"discounted_cash":21.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Transthoracic Echo (Tte), Congenital, Complete (Global) 93303","code_information":[{"code":"2388722","type":"CDM"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.47,"discounted_cash":184.59,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":129.38,"discounted_cash":51.75,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Transesophageal Echo (Tee) 2D, Includes Probe Plcmt, Image Acq, I&R (Global) 93312","code_information":[{"code":"2388727","type":"CDM"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.53,"discounted_cash":239.81,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":247.34,"discounted_cash":98.94,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Transesophageal Echo (Tee) 2D, Probe Plcmt Only 93313","code_information":[{"code":"2388728","type":"CDM"},{"code":"93313","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.16,"discounted_cash":18.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Doppler Echo, Complete (Global) 93320","code_information":[{"code":"2388734","type":"CDM"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":42.67,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":37.43,"discounted_cash":14.97,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Right Heart Cath (Rhc) Only 93451","code_information":[{"code":"2388740","type":"CDM"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.25,"discounted_cash":606.5,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":292.14,"discounted_cash":116.86,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Left Heart Cath (Lhc) Only 93452","code_information":[{"code":"2388741","type":"CDM"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.36,"discounted_cash":205.34,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":513.36,"discounted_cash":205.34,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Right & Left Heart Cath (Rhc/Lhc) 93453","code_information":[{"code":"2388742","type":"CDM"},{"code":"93453","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.82,"discounted_cash":269.93,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":674.82,"discounted_cash":269.93,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Selective Coronary Angiography (Sca) 93454","code_information":[{"code":"2388743","type":"CDM"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.44,"discounted_cash":696.18,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":516.69,"discounted_cash":206.68,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Selective Coronary (Sca) & Bypass Graft Angio 93455","code_information":[{"code":"2388744","type":"CDM"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":2026.41,"discounted_cash":810.56,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":598.06,"discounted_cash":239.22,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Selective Coronary Angio (Sca) W/Right Heart Cath (Rhc) 93456","code_information":[{"code":"2388746","type":"CDM"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.09,"discounted_cash":871.64,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":664.28,"discounted_cash":265.71,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Selective Coronary Angio (Sca) W/Right & Left Heart Cath (Rhc&Lhc) 93460","code_information":[{"code":"2388750","type":"CDM"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2476.09,"discounted_cash":990.44,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":791.88,"discounted_cash":316.75,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Selective Coronary (Sca) & Byp Angio W/Right & Left Heart Cath (Rhc&Lhc) 93461","code_information":[{"code":"2388751","type":"CDM"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":2829.77,"discounted_cash":1131.91,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":873.93,"discounted_cash":349.57,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Pharmacological Agent Administration (Eg, Inhaled Nitric Oxide) 93463","code_information":[{"code":"2388753","type":"CDM"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.34,"discounted_cash":80.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insert Flow Direct Cath For Monitoring (Ie, Swan-Ganz) 93503","code_information":[{"code":"2388755","type":"CDM"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.24,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Complete Pft 94150","code_information":[{"code":"2388855","type":"CDM"},{"code":"510","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.54,"discounted_cash":19.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Pulm Function Test Plethysmograp 94726","code_information":[{"code":"2388878","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":390.0,"discounted_cash":156.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":260.0,"discounted_cash":104.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":25.17,"discounted_cash":10.07,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Allergy Tests, Drugs/Biologicals, Any Combo, # Of Tests 95018","code_information":[{"code":"2388898","type":"CDM"},{"code":"95018","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Allergen Immunotherapy, Preparation, 1 Or Multi Antigens, # Doses 95165","code_information":[{"code":"2388925","type":"CDM"},{"code":"95165","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Mlt Sleep Latency/Maint Of Wakefulness Plus Interp 95805","code_information":[{"code":"2388936","type":"CDM"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.21,"discounted_cash":323.28,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":119.96,"discounted_cash":47.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Sleep Study (Unattnd) 95806","code_information":[{"code":"2388937","type":"CDM"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.99,"discounted_cash":131.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":328.99,"discounted_cash":131.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Eeg W/Recording In Coma Or Sleep Only 95822","code_information":[{"code":"2388946","type":"CDM"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.77,"discounted_cash":35.11,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":87.77,"discounted_cash":35.11,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Cholinesterase Inhibitor Challenge Test 95857","code_information":[{"code":"2388957","type":"CDM"},{"code":"95857","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.33,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Needle Electromyography (Emg), 2 Extremity 95861","code_information":[{"code":"2388959","type":"CDM"},{"code":"922","type":"RC"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.27,"discounted_cash":135.71,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":135.71,"discounted_cash":54.28,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":204.0,"discounted_cash":81.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":339.27,"discounted_cash":135.71,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Needle Electromyography (Emg), 3 Extremity 95863","code_information":[{"code":"2388960","type":"CDM"},{"code":"95863","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.01,"discounted_cash":167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Needle Emg Guid W/Chemodenervation 95874","code_information":[{"code":"2388970","type":"CDM"},{"code":"922","type":"RC"},{"code":"95874","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.88,"discounted_cash":93.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":139.72,"discounted_cash":55.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":93.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":232.88,"discounted_cash":93.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Nrv Cndj, Each Limb W/ Interp & Rpt 95905","code_information":[{"code":"2388975","type":"CDM"},{"code":"95905","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.05,"discounted_cash":54.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Nrv Cndj 1-2 Electrode Limb 95907","code_information":[{"code":"2388976","type":"CDM"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.68,"discounted_cash":76.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Somatosensory Extremity Upper Limbs 95925","code_information":[{"code":"2388987","type":"CDM"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.32,"discounted_cash":121.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Somatosensory Extremity Lower Limbs 95926","code_information":[{"code":"2388988","type":"CDM"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.37,"discounted_cash":111.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Somatosensory Extremity Upper/Lower Limbs 95938","code_information":[{"code":"2388995","type":"CDM"},{"code":"510","type":"RC"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.35,"discounted_cash":262.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":394.41,"discounted_cash":157.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":263.0,"discounted_cash":105.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":657.35,"discounted_cash":262.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Selective Debridement, Ea Adtl 20 Sq Cm 97598","code_information":[{"code":"2389140","type":"CDM"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.52,"discounted_cash":9.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Negative Pressure Wound Therapy, Less Than  Or Equal Too 50 Sq Cm 97605","code_information":[{"code":"2389142","type":"CDM"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.19,"discounted_cash":22.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Medical Nutrition Assmt Indiv Each 15 Min 97802","code_information":[{"code":"2389150","type":"CDM"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.58,"discounted_cash":26.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Medical Nutrition Re-Assmt Indiv Ea 15 Min 97803","code_information":[{"code":"2389151","type":"CDM"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.04,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Supplies Plus Materials Prv By Phys Greater Than Plus Above 99070","code_information":[{"code":"2389185","type":"CDM"},{"code":"99070","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Hyperbaric Oxygen Therapy 99183","code_information":[{"code":"2389208","type":"CDM"},{"code":"99183","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.68,"discounted_cash":89.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Selective Debridement, 1St 20 Sq Cm 97597","code_information":[{"code":"2389275","type":"CDM"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.87,"discounted_cash":19.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Injection Therapeutic Carpal Tunnel 20526","code_information":[{"code":"2389279","type":"CDM"},{"code":"510","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.25,"discounted_cash":139.7,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":209.55,"discounted_cash":83.82,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":140.0,"discounted_cash":56.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Injection Of Single Or Multiple Trigger Points 1 Or 2 Muscles","code_information":[{"code":"2389282","type":"CDM"},{"code":"510","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Injection Single Or Mlt Trigger Point 3 Or More Muscles 20553","code_information":[{"code":"2389283","type":"CDM"},{"code":"510","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":276.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":414.0,"discounted_cash":165.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":276.0,"discounted_cash":110.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Small Joint Or Bursa Arthrocenteses Aspiraton Or Injection","code_information":[{"code":"2389284","type":"CDM"},{"code":"510","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1600.0,"discounted_cash":640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."},{"gross_charge":95.01,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Aspiration Injection Ganglion Cyst","code_information":[{"code":"2389287","type":"CDM"},{"code":"510","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Fetal Nonstress Test 59025","code_information":[{"code":"2389290","type":"CDM"},{"code":"510","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.35,"discounted_cash":169.74,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":254.61,"discounted_cash":101.84,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":170.0,"discounted_cash":68.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":59.76,"discounted_cash":23.9,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy 81000","code_information":[{"code":"2389297","type":"CDM"},{"code":"81000","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.92,"discounted_cash":3.57,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Urine Pregnancy Test Visual Color Cmprsn Meths 81025","code_information":[{"code":"2389303","type":"CDM"},{"code":"510","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.86,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Albumin Urine Microalbumin Semiquantitative 82044","code_information":[{"code":"2389305","type":"CDM"},{"code":"82044","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.92,"discounted_cash":5.17,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Blood Occult Peroxidase Actv Qual Feces 1 Deter 82270","code_information":[{"code":"2389306","type":"CDM"},{"code":"510","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":11.0,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Non-Screening Blood Occult Cards 82272","code_information":[{"code":"2389307","type":"CDM"},{"code":"510","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":11.0,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Creatinine Other Source 82570","code_information":[{"code":"2389310","type":"CDM"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.61,"discounted_cash":5.84,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Glucose Blood Monitor (Fingerstick) 82962","code_information":[{"code":"2389313","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":29.0,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hemoglobin Glycosylated A1C 83036","code_information":[{"code":"2389314","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Blood Count Hemoglobin 85018","code_information":[{"code":"2389326","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Heterophile Antibodies Screen 86308","code_information":[{"code":"2389332","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.61,"discounted_cash":5.84,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Skin Test Tuberculosis Intradermal 86580","code_information":[{"code":"2389335","type":"CDM"},{"code":"309","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.16,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Iaadiadoo Respiratory Synctial Virus 87807","code_information":[{"code":"2389341","type":"CDM"},{"code":"510","type":"RC"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.82,"discounted_cash":21.53,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Iaadiadoo Streptococcus Group A 87880","code_information":[{"code":"2389342","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.87,"discounted_cash":13.55,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":34.0,"discounted_cash":13.6,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Observation Care Discharge Management 99217","code_information":[{"code":"2389421","type":"CDM"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Initial Observation Care/Day Low Severity","code_information":[{"code":"2389422","type":"CDM"},{"code":"510","type":"RC"},{"code":"99221","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Initial Hospital Inpatient Or Observation Care","code_information":[{"code":"2389423","type":"CDM"},{"code":"510","type":"RC"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":109.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":274.0,"discounted_cash":109.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Observation Care/Day High Severity","code_information":[{"code":"2389424","type":"CDM"},{"code":"510","type":"RC"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Sbsq Hospital Care/Day 15 Minutes 99231","code_information":[{"code":"2389431","type":"CDM"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Sbsq Hospital Care/Day 25 Minutes 99232","code_information":[{"code":"2389432","type":"CDM"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Sbsq Hospital Care/Day 35 Minutes 99233","code_information":[{"code":"2389433","type":"CDM"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Observation/Inpatient Hospital Care Low Severity 99234","code_information":[{"code":"2389434","type":"CDM"},{"code":"99234","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Observation/Inpatient Hospital Care Mod Severity 99235","code_information":[{"code":"2389435","type":"CDM"},{"code":"99235","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Observation/Inpatient Hospital Care Hi Severity 99236","code_information":[{"code":"2389436","type":"CDM"},{"code":"99236","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Hospital Discharge Day Management 30 Min/Less Than 99238","code_information":[{"code":"2389437","type":"CDM"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Hospital Discharge Day Management > 30 Min 99239","code_information":[{"code":"2389438","type":"CDM"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Initial Inpatient Consult New/Estab Pt","code_information":[{"code":"2389445","type":"CDM"},{"code":"99252","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Initial Inpatient Consult New/Estab Pt 55 Min 99253","code_information":[{"code":"2389446","type":"CDM"},{"code":"99253","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Initial Inpatient Consult New/Estab Pt 80 Min 99254","code_information":[{"code":"2389447","type":"CDM"},{"code":"99254","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":111.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Initial Inpatient Consult New/Estab Pt 110 Min 99255","code_information":[{"code":"2389448","type":"CDM"},{"code":"99255","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Emergency Department Visit Limited/Minor Prob 99281","code_information":[{"code":"2389449","type":"CDM"},{"code":"510","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Emergency Department Visit Low/Moder Severity 99282","code_information":[{"code":"2389450","type":"CDM"},{"code":"510","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Emergency Department Visit Moderate Severity 99283","code_information":[{"code":"2389451","type":"CDM"},{"code":"510","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Emergency Department Visit High/Urgent Severity 99284","code_information":[{"code":"2389452","type":"CDM"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":95.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Initial Nursing Facility Care/Day Low Severity 99304","code_information":[{"code":"2389457","type":"CDM"},{"code":"99304","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":184.15,"discounted_cash":73.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Nursing Facility Care/Day Moder Severity 99305","code_information":[{"code":"2389458","type":"CDM"},{"code":"99305","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":105.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":262.83,"discounted_cash":105.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Nursing Facility Care/Day High Severity 99306","code_information":[{"code":"2389459","type":"CDM"},{"code":"99306","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":335.4,"discounted_cash":134.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Sbsq Nursing Facility Care/Day E/M Stable 10 Min 99307","code_information":[{"code":"2389460","type":"CDM"},{"code":"99307","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":89.18,"discounted_cash":35.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Sbsq Nursing Facil Care/Day Minor Complj 15 Min 99308","code_information":[{"code":"2389461","type":"CDM"},{"code":"99308","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":137.63,"discounted_cash":55.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Sbsq Nursing Facil Care/Day New Problem 25 Min 99309","code_information":[{"code":"2389462","type":"CDM"},{"code":"99309","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":182.49,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Sbsq Nurs Facil Care/Day Unstabl/New Prob 35 Min 99310","code_information":[{"code":"2389463","type":"CDM"},{"code":"99310","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":108.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":271.65,"discounted_cash":108.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Nursing Facility Discharge Management 30 Min/Less Than 99315","code_information":[{"code":"2389464","type":"CDM"},{"code":"99315","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":146.41,"discounted_cash":58.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Dom/R-Home E/M Est Pt Self-Lmtd/Minor 99334","code_information":[{"code":"2389472","type":"CDM"},{"code":"99347","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":120.76,"discounted_cash":48.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Home Visit New Patient Hi Severity 60 Min 99344","code_information":[{"code":"2389481","type":"CDM"},{"code":"99344","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":146.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":366.22,"discounted_cash":146.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Prolonged Service I/P Req Unit/Floor Time 1St Hr 99418","code_information":[{"code":"2389489","type":"CDM"},{"code":"99418","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Initial Preventive Medicine New Patient 65Yrs Plus Greater Than 99387","code_information":[{"code":"2389510","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":258.75,"discounted_cash":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Tobacco Use Cessation Intensive >10 Minutes 99407","code_information":[{"code":"2389523","type":"CDM"},{"code":"942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":31.0,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":51.67,"discounted_cash":20.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Admn Plus Interpj Health Risk Assessment Instrument 96160","code_information":[{"code":"2389528","type":"CDM"},{"code":"510","type":"RC"},{"code":"96160","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":31.0,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":51.75,"discounted_cash":20.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"1St Hosp/Birthing Center Care Per Day Nml Nb 99460","code_information":[{"code":"2389537","type":"CDM"},{"code":"99460","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"1St Care Pr Day Nml Nb Xcpt Hosp/Birthing Center 99461","code_information":[{"code":"2389538","type":"CDM"},{"code":"99461","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":127.28,"discounted_cash":50.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Subq Hospital Care Per Day E/M Normal Newborn 99462","code_information":[{"code":"2389539","type":"CDM"},{"code":"99462","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"1St Hosp/Birthing Center Nb Admit+Dschg Sm Date 99463","code_information":[{"code":"2389540","type":"CDM"},{"code":"510","type":"RC"},{"code":"99463","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":96.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Attn At Delivery Plus 1 Stabilization Of Newborn 99464","code_information":[{"code":"2389541","type":"CDM"},{"code":"510","type":"RC"},{"code":"99464","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Critical Care Interfacility Transport 30-74 Min 99466","code_information":[{"code":"2389543","type":"CDM"},{"code":"99466","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"1St Inpatient Critical Care Pr Day Age 28 Days/Less Than 99468","code_information":[{"code":"2389545","type":"CDM"},{"code":"99468","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1859.5,"discounted_cash":743.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Subsequent Intensive Care Infant 2501-5000 Grams 99480","code_information":[{"code":"2389554","type":"CDM"},{"code":"99480","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.13,"discounted_cash":96.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Ct Abdomen And Pelvis W/ + W/O Contrast","code_information":[{"code":"2424644","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":7385.0,"discounted_cash":2954.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abdomen And Pelvis W/ Contrast","code_information":[{"code":"2424647","type":"CDM"},{"code":"352","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":5576.0,"discounted_cash":2230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abdomen And Pelvis W/O Contrast","code_information":[{"code":"2424650","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":4510.0,"discounted_cash":1804.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Abdomen And Pelvis","code_information":[{"code":"2424686","type":"CDM"},{"code":"350","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":3006.0,"discounted_cash":1202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Pulmonary (Pe)","code_information":[{"code":"2424695","type":"CDM"},{"code":"350","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3077.0,"discounted_cash":1230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Bone Deep","code_information":[{"code":"2424722","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Bone Marrow W/ Bone Marrow Asp","code_information":[{"code":"2424725","type":"CDM"},{"code":"360","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5164.0,"discounted_cash":2065.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Lymph Node","code_information":[{"code":"2424728","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Muscle","code_information":[{"code":"2424731","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Neck Or Chest","code_information":[{"code":"2424734","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Pelvis/Hip","code_information":[{"code":"2424737","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Retroperitoneal Abdomen","code_information":[{"code":"2424740","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abscess/Cyst Drainage","code_information":[{"code":"2424746","type":"CDM"},{"code":"350","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Fine Needle Aspiration W/ Guidance","code_information":[{"code":"2424767","type":"CDM"},{"code":"350","type":"RC"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":1779.0,"discounted_cash":711.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Heart + Eval W/ Contrast","code_information":[{"code":"2424776","type":"CDM"},{"code":"359","type":"RC"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":2896.0,"discounted_cash":1158.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Heart Calcium Scoring","code_information":[{"code":"2424782","type":"CDM"},{"code":"359","type":"RC"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":1632.0,"discounted_cash":652.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Paracentesis Abdominal W/ Ct Guidance","code_information":[{"code":"2424827","type":"CDM"},{"code":"320","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":876.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Thoracentesis W/ Ct Guidance","code_information":[{"code":"2424869","type":"CDM"},{"code":"360","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":1898.0,"discounted_cash":759.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Aaa Screening Medicare","code_information":[{"code":"2425290","type":"CDM"},{"code":"402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1602.0,"discounted_cash":640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Aspiration Abscess/Hematoma/Cyst","code_information":[{"code":"2425296","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Biopsy Muscle","code_information":[{"code":"2425299","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Breast Cyst Aspiration Left","code_information":[{"code":"2425311","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Breast Cyst Aspiration Right","code_information":[{"code":"2425314","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Extremity Nonvascular Complete","code_information":[{"code":"2425338","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Extremity Nonvascular Complete - Report","code_information":[{"code":"2425340","type":"CDM"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Fine Needle Aspiration W/ Guidance","code_information":[{"code":"2425347","type":"CDM"},{"code":"361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1779.0,"discounted_cash":711.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Pelvis Comp W/Transvag If Indicated","code_information":[{"code":"2425368","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"discounted_cash":447.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Vessel Mapping For Dialysis","code_information":[{"code":"2425374","type":"CDM"},{"code":"921","type":"RC"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":273.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Ercp","code_information":[{"code":"2425449","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Ivp W/ Bolus","code_information":[{"code":"2425503","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Injection Contrast For Tube Eval","code_information":[{"code":"2425518","type":"CDM"},{"code":"320","type":"RC"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Joint/Bursa Major Arthr/Asp/Inj Left","code_information":[{"code":"2425554","type":"CDM"},{"code":"360","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":387.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Lumbar Puncture","code_information":[{"code":"2425572","type":"CDM"},{"code":"360","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.0,"discounted_cash":855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Tube Placement Ng Gastric (Stomach)","code_information":[{"code":"2425629","type":"CDM"},{"code":"320","type":"RC"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Tube Reposition Gastric","code_information":[{"code":"2425638","type":"CDM"},{"code":"320","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2559.0,"discounted_cash":1023.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Dialysis Fistula Graft","code_information":[{"code":"2425687","type":"CDM"},{"code":"320","type":"RC"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3237.0,"discounted_cash":1294.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mg Breast Tomo 3D Digital Diag Bilateral","code_information":[{"code":"2425793","type":"CDM"},{"code":"401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mg Mammo Digital Screening Left","code_information":[{"code":"2425802","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","modifiers":"LT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier 52: Reduced Services"}]},{"description":"Mg Mammo Digital Screening Right","code_information":[{"code":"2425805","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","modifiers":"52|RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mg Breast Biopsy W/ Stereo Guide Left","code_information":[{"code":"2425835","type":"CDM"},{"code":"361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":3729.0,"discounted_cash":1491.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mg Breast Biopsy W/ Stereo Guide Right","code_information":[{"code":"2425838","type":"CDM"},{"code":"361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":3729.0,"discounted_cash":1491.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Nm Thyroid Image W/ Uptake Sngl Or Multi","code_information":[{"code":"2425944","type":"CDM"},{"code":"341","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.0,"discounted_cash":504.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Hepatobiliary Imaging","code_information":[{"code":"2425954","type":"CDM"},{"code":"320","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.0,"discounted_cash":625.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Hepatobiliary Imaging W/ Drug","code_information":[{"code":"2425957","type":"CDM"},{"code":"341","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.0,"discounted_cash":625.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Lung Vent/Perf Differential Imaging","code_information":[{"code":"2425963","type":"CDM"},{"code":"341","type":"RC"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Lung Vent/Perf Imaging","code_information":[{"code":"2425966","type":"CDM"},{"code":"320","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.0,"discounted_cash":643.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Myocardial Spect Rest And Stress","code_information":[{"code":"2425975","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":4319.0,"discounted_cash":1727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Myocardial Planar Single Study","code_information":[{"code":"2425978","type":"CDM"},{"code":"341","type":"RC"},{"code":"78454","type":"HCPCS"}],"standard_charges":[{"gross_charge":2023.0,"discounted_cash":809.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Myocardial Spect Single Study","code_information":[{"code":"2425981","type":"CDM"},{"code":"341","type":"RC"},{"code":"78469","type":"HCPCS"}],"standard_charges":[{"gross_charge":2069.0,"discounted_cash":827.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Radiopharm Therapy Iv Admin","code_information":[{"code":"2425996","type":"CDM"},{"code":"342","type":"RC"},{"code":"77750","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Sentinel Node","code_information":[{"code":"2426002","type":"CDM"},{"code":"361","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":446.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"VIT A&D TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000001","type":"CDM"},{"code":"259","type":"RC"},{"code":"71399012204A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TACROLIMUS 5MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000003","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7525","type":"HCPCS"},{"code":"00469301601","type":"NDC"}],"standard_charges":[{"gross_charge":605.44,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 1MG/1ML INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000018","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"42023015925B","type":"NDC"}],"standard_charges":[{"gross_charge":85.2,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYMETAZOLINE N","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000026","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122016510A","type":"NDC"}],"standard_charges":[{"gross_charge":28.43,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"FENTANYL 5MCG/BUP 1/16 250 ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500000028","type":"CDM"},{"code":"250","type":"RC"},{"code":"70004023440","type":"NDC"}],"standard_charges":[{"gross_charge":360.68,"discounted_cash":144.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTON 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000047","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079010320","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIKACIN 500MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000062","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 1/2 N-S +30 KCL 1000","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500000063","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990790309A","type":"NDC"}],"standard_charges":[{"gross_charge":78.72,"discounted_cash":31.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMERICAINE R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000066","type":"CDM"},{"code":"259","type":"RC"},{"code":"63736037501A","type":"NDC"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":8.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"AMINOPHYLLIN 250MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000075","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 500MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000090","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"44567010110A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE UP TO 20 MG UN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000107","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030110A","type":"NDC"}],"standard_charges":[{"gross_charge":113.8,"discounted_cash":45.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIVENIN CROTALIDAE","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500000109","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0840","type":"HCPCS"},{"code":"50633011012","type":"NDC"}],"standard_charges":[{"gross_charge":15948.58,"discounted_cash":6379.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Bupivacaine 0.5% 10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000111","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409116201A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MECLIZINE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000112","type":"CDM"},{"code":"259","type":"RC"},{"code":"69618002801A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANUSOL HC R","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000115","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713050324","type":"NDC"}],"standard_charges":[{"gross_charge":24.63,"discounted_cash":9.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANUSOL HC CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000116","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980032430A","type":"NDC"}],"standard_charges":[{"gross_charge":94.36,"discounted_cash":37.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"HYDRALAZINE 20MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000119","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00517090125A","type":"NDC"}],"standard_charges":[{"gross_charge":120.82,"discounted_cash":48.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500000120","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"00078024815","type":"NDC"}],"standard_charges":[{"gross_charge":1346.93,"discounted_cash":538.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000121","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079007420A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE 1MG I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500000123","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"00409915701","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE 10MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000124","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":251.08,"discounted_cash":100.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINZESS 145MG CAP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000125","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456120130A","type":"NDC"}],"standard_charges":[{"gross_charge":40.72,"discounted_cash":16.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MCG"}]},{"description":"TRIHEXYPHENIDY 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500000145","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591533501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASA 325MG T","drug_information":{"unit":"325","type":"ME"},"code_information":[{"code":"2500000155","type":"CDM"},{"code":"259","type":"RC"},{"code":"66553000101","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE H 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000159","type":"CDM"},{"code":"259","type":"RC"},{"code":"16714008110A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 1MG TAB","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500000163","type":"CDM"},{"code":"259","type":"RC"},{"code":"00187006401B","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE ABBOJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000166","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409491134","type":"NDC"}],"standard_charges":[{"gross_charge":45.1,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 1MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000170","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729052608A","type":"NDC"}],"standard_charges":[{"gross_charge":71.54,"discounted_cash":28.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 0.4MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000171","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729052508A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 1% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000173","type":"CDM"},{"code":"259","type":"RC"},{"code":"60219174903A","type":"NDC"}],"standard_charges":[{"gross_charge":21.17,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"FEXO60C","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500000174","type":"CDM"},{"code":"259","type":"RC"},{"code":"55111078301A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSEUXRI20T","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2500000175","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122016660A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN B12 UP TO 1000 MCG UNI","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000190","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"gross_charge":41.48,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 LR +20 KCL 1000","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500000202","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338081104A","type":"NDC"}],"standard_charges":[{"gross_charge":78.55,"discounted_cash":31.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMI 50MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000203","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMI 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000205","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0163","type":"HCPCS"},{"code":"00904723761A","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMI 50MG C","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500000206","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0163","type":"HCPCS"},{"code":"00904530780A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENIHYDRA 12.5/5 L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000208","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0163","type":"HCPCS"},{"code":"00121097800","type":"NDC"}],"standard_charges":[{"gross_charge":17.85,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROBENECID T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500000211","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378015601","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000215","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079011820","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE IODINE TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000227","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536127180A","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"PEN LA 600 000U I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000235","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070010","type":"NDC"}],"standard_charges":[{"gross_charge":566.14,"discounted_cash":226.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE INJ","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000236","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":858.56,"discounted_cash":343.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500000248","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527131801A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lidocaine 2% 10ml vial MDV","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000254","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150025410A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM 133MG TAB","drug_information":{"unit":"133","type":"ME"},"code_information":[{"code":"2500000270","type":"CDM"},{"code":"259","type":"RC"},{"code":"96974000002A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NADOLO 20 TABLET","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500000271","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079081220A","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":6.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE 0.25% 10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000277","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150016710A","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CA CL 10% ABBOJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000280","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409492834","type":"NDC"}],"standard_charges":[{"gross_charge":44.67,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CA GLUC 4.65MEQ I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000284","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"63323036019A","type":"NDC"}],"standard_charges":[{"gross_charge":52.22,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASTOR OIL 20Z L","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500000287","type":"CDM"},{"code":"259","type":"RC"},{"code":"00395051592","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE 1% I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500000291","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323026037A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE 2% I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500000292","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323029427A","type":"NDC"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.1MG T","drug_information":{"unit":"0.1","type":"ME"},"code_information":[{"code":"2500000301","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001023700A","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZO/MENTHOL SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000304","type":"CDM"},{"code":"259","type":"RC"},{"code":"78112001104","type":"NDC"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"CHLORASPETIC LOZ","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000305","type":"CDM"},{"code":"259","type":"RC"},{"code":"67172002118A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 LOZENGE"}]},{"description":"BETAMETHASONE AC/SP 12MG/2ML","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000323","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001A","type":"NDC"}],"standard_charges":[{"gross_charge":117.33,"discounted_cash":46.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAMETHASONE AC/SP 12MG/2ML","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000323","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"gross_charge":117.33,"discounted_cash":46.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAG CITRATE L","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000339","type":"CDM"},{"code":"259","type":"RC"},{"code":"00869068638A","type":"NDC"}],"standard_charges":[{"gross_charge":6.46,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 OZ"}]},{"description":"MAG CITRATE L","drug_information":{"unit":"296","type":"ML"},"code_information":[{"code":"2500000339","type":"CDM"},{"code":"259","type":"RC"},{"code":"00869068638B","type":"NDC"}],"standard_charges":[{"gross_charge":6.46,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 150MG C","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500000342","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084024301","type":"NDC"}],"standard_charges":[{"gross_charge":18.59,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINORIL TAB","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500000345","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591566101","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500000351","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084038801A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE 100/10 L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000352","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121187000","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE NA 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500000354","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687012901A","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE UP TO 10 MG U","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000364","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70069037125A","type":"NDC"}],"standard_charges":[{"gross_charge":102.48,"discounted_cash":40.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORT 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000379","type":"CDM"},{"code":"259","type":"RC"},{"code":"42543014101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CORTENEMA R","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2500000380","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559011107A","type":"NDC"}],"standard_charges":[{"gross_charge":60.46,"discounted_cash":24.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLY/NEO/HC OT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000383","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":375.81,"discounted_cash":150.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"NEO/POLY B/HC OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000386","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314064175","type":"NDC"}],"standard_charges":[{"gross_charge":244.26,"discounted_cash":97.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"WARFARIN 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500000390","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084002701A","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500000391","type":"CDM"},{"code":"259","type":"RC"},{"code":"62584099401A","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000392","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093172001A","type":"NDC"}],"standard_charges":[{"gross_charge":8.83,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EYE STREAM OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000407","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536122497A","type":"NDC"}],"standard_charges":[{"gross_charge":37.45,"discounted_cash":14.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"MORPHINE SULFATE 10MG/0.5ML SY","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500000422","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094004558A","type":"NDC"}],"standard_charges":[{"gross_charge":13.51,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASO 0.75MG T","drug_information":{"unit":"0.75","type":"ME"},"code_information":[{"code":"2500000429","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054818025","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETH 4MG IML I PER 1 MG UN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000432","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016501A","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOBENZAPRINE 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500000448","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378077101A","type":"NDC"}],"standard_charges":[{"gross_charge":7.78,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE 50MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000450","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641605325C","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500000458","type":"CDM"},{"code":"259","type":"RC"},{"code":"42806005030A","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000459","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054354563","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED 40MG SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000461","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009307323","type":"NDC"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXY 150MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000462","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993037083A","type":"NDC"}],"standard_charges":[{"gross_charge":464.43,"discounted_cash":185.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESITIN OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000465","type":"CDM"},{"code":"259","type":"RC"},{"code":"74300000300A","type":"NDC"}],"standard_charges":[{"gross_charge":16.71,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"D50W ABBOJ","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500000475","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409490234","type":"NDC"}],"standard_charges":[{"gross_charge":97.17,"discounted_cash":38.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5S 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500000477","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00990794103A","type":"NDC"}],"standard_charges":[{"gross_charge":68.86,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5S 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500000478","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990794109A","type":"NDC"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":26.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5W 250ML IV","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500000479","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990792202A","type":"NDC"}],"standard_charges":[{"gross_charge":53.96,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5W 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500000480","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00990792255A","type":"NDC"}],"standard_charges":[{"gross_charge":53.9,"discounted_cash":21.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500000481","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264751000A","type":"NDC"}],"standard_charges":[{"gross_charge":63.03,"discounted_cash":25.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D10W 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500000482","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990793009A","type":"NDC"}],"standard_charges":[{"gross_charge":72.39,"discounted_cash":28.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMID 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500000496","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"00143950301A","type":"NDC"}],"standard_charges":[{"gross_charge":186.91,"discounted_cash":74.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMID 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500000497","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084040121A","type":"NDC"}],"standard_charges":[{"gross_charge":24.87,"discounted_cash":9.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE EPI 2% 1:200K 10ML V","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000498","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048917A","type":"NDC"}],"standard_charges":[{"gross_charge":42.38,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lidocaine 2% 20ml contains pre","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500000512","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409427716A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lido/Epi 1.5% 30ml MPF SDV","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500000513","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048837A","type":"NDC"}],"standard_charges":[{"gross_charge":64.55,"discounted_cash":25.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500000514","type":"CDM"},{"code":"259","type":"RC"},{"code":"00071036940A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 100MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000515","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"00641049325A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500000520","type":"CDM"},{"code":"259","type":"RC"},{"code":"42858030101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 2MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000521","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00641234141A","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYL/BROM L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000528","type":"CDM"},{"code":"259","type":"RC"},{"code":"00031223513A","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRALEMENT-4 CONC INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000531","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517930525A","type":"NDC"}],"standard_charges":[{"gross_charge":102.05,"discounted_cash":40.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 25% INFANT INJ 10ML","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000533","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409177510A","type":"NDC"}],"standard_charges":[{"gross_charge":45.15,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500000538","type":"CDM"},{"code":"259","type":"RC"},{"code":"00832003801A","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUMINUM ACETATE PACKET","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000543","type":"CDM"},{"code":"250","type":"RC"},{"code":"16864024001A","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"HYDROXOCOBALAMIN 5 GM","drug_information":{"unit":"5","type":"GM"},"code_information":[{"code":"2500000550","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779253303A","type":"NDC"}],"standard_charges":[{"gross_charge":3413.31,"discounted_cash":1365.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BELLADON ALK/PHENO L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000553","type":"CDM"},{"code":"259","type":"RC"},{"code":"59212042316A","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAPRAM 20MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500000557","type":"CDM"},{"code":"250","type":"RC"},{"code":"55390003501","type":"NDC"}],"standard_charges":[{"gross_charge":358.87,"discounted_cash":143.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISACODYL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500000568","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904640761A","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISACODYL 10MG R","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000569","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574705012A","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASA E.C. 325MG T","drug_information":{"unit":"325","type":"ME"},"code_information":[{"code":"2500000580","type":"CDM"},{"code":"259","type":"RC"},{"code":"57896092101A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLLIN 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000592","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687043301A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPI ABBOJ SHORT","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000614","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329331801A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPSOM SALTS TOP","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500000619","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677121001A","type":"NDC"}],"standard_charges":[{"gross_charge":14.62,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERY BASE 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500000628","type":"CDM"},{"code":"259","type":"RC"},{"code":"75834024201A","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERY 500MG IVPB","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500000629","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"00409648201","type":"NDC"}],"standard_charges":[{"gross_charge":386.34,"discounted_cash":154.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SUL 324MG T","drug_information":{"unit":"325","type":"ME"},"code_information":[{"code":"2500000657","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904759161A","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOL 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500000665","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155065101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEET ENEMA R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000667","type":"CDM"},{"code":"259","type":"RC"},{"code":"00132020140A","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEET OIL MINERAL R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000668","type":"CDM"},{"code":"259","type":"RC"},{"code":"00132030140","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEET PED ENEMA R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000669","type":"CDM"},{"code":"259","type":"RC"},{"code":"00132020220","type":"NDC"}],"standard_charges":[{"gross_charge":6.46,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOBENZAPRI 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000672","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079064420A","type":"NDC"}],"standard_charges":[{"gross_charge":9.64,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUORESCEIN STRIP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000675","type":"CDM"},{"code":"250","type":"RC"},{"code":"17238090030A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 500MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000677","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":177.14,"discounted_cash":70.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500000678","type":"CDM"},{"code":"259","type":"RC"},{"code":"53746036101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID 5MG I","drug_information":{"unit":"0.2","type":"ML"},"code_information":[{"code":"2500000679","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":101.41,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Acamprosate 333 mg tab","drug_information":{"unit":"333","type":"ME"},"code_information":[{"code":"2500000687","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904721304A","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMM GLOB 5GM IV","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500000694","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085002A","type":"NDC"}],"standard_charges":[{"gross_charge":4306.32,"discounted_cash":1722.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 80MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000699","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00409120703","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000701","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802004611","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"GENTAMICIN CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000702","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802005611","type":"NDC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":24.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"GENTAMICIN OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000704","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208058060A","type":"NDC"}],"standard_charges":[{"gross_charge":86.63,"discounted_cash":34.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"FOAMING ANTACID T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000707","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904536560A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 80MG IVPB","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000715","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050941A","type":"NDC"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 60MG IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500000716","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050741A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON 1MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000727","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"63323059303A","type":"NDC"}],"standard_charges":[{"gross_charge":861.12,"discounted_cash":344.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN L","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"2500000728","type":"CDM"},{"code":"250","type":"RC"},{"code":"00395103116","type":"NDC"}],"standard_charges":[{"gross_charge":53.88,"discounted_cash":21.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERINE R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000729","type":"CDM"},{"code":"259","type":"RC"},{"code":"58980041025A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPP"}]},{"description":"CLOTRIMAZOLE CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000744","type":"CDM"},{"code":"259","type":"RC"},{"code":"61269022063A","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"HALOPERIDOL 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500000745","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079073420","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN 1000 U/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000750","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409272101A","type":"NDC"}],"standard_charges":[{"gross_charge":39.87,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TET IM GLOB 250U I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000760","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1670","type":"HCPCS"},{"code":"13533063402","type":"NDC"}],"standard_charges":[{"gross_charge":2774.79,"discounted_cash":1109.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HCTZ 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500000763","type":"CDM"},{"code":"259","type":"RC"},{"code":"16729018401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HCTZ 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000764","type":"CDM"},{"code":"259","type":"RC"},{"code":"00172208380A","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000778","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591555401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE 2MG C","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500000787","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079069020","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DROPERIODOL 2ML","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000791","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00517970225A","type":"NDC"}],"standard_charges":[{"gross_charge":42.55,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500000795","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378018301A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 1MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000796","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"63323060401A","type":"NDC"}],"standard_charges":[{"gross_charge":70.61,"discounted_cash":28.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDIGO 5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000797","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517037510","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOMETHACIN 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000798","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462040601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON DEXTRAN I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000803","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210A","type":"NDC"}],"standard_charges":[{"gross_charge":165.76,"discounted_cash":66.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000820","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517190525","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISONIAZID 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500000829","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079008320","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE 1% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000834","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":98.4,"discounted_cash":39.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"PILOCARPINE 2% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000835","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314020415A","type":"NDC"}],"standard_charges":[{"gross_charge":99.56,"discounted_cash":39.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CARBACHOL 3% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000838","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314020615","type":"NDC"}],"standard_charges":[{"gross_charge":148.18,"discounted_cash":59.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"ISOSORBIDE 5L 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500000841","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781163501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000842","type":"CDM"},{"code":"259","type":"RC"},{"code":"00143177101a","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOPROTERENOL I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000847","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485011310A","type":"NDC"}],"standard_charges":[{"gross_charge":54.6,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA POLYSTYRENE 60ML","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2500000859","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":41.57,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250MG C","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500000861","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180012101","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500000862","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180012201","type":"NDC"}],"standard_charges":[{"gross_charge":22.45,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEX 250MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000864","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093417773A","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 1GM IVPB","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500000869","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021010110B","type":"NDC"}],"standard_charges":[{"gross_charge":40.19,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KENALOG 5GM ORABASE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000876","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672126705","type":"NDC"}],"standard_charges":[{"gross_charge":327.2,"discounted_cash":130.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TRIAMCINOLONE 40MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000879","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104905A","type":"NDC"}],"standard_charges":[{"gross_charge":48.41,"discounted_cash":19.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE 50MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000881","type":"CDM"},{"code":"250","type":"RC"},{"code":"69374098255A","type":"NDC"}],"standard_charges":[{"gross_charge":111.35,"discounted_cash":44.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE 10MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500000882","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023011310","type":"NDC"}],"standard_charges":[{"gross_charge":85.4,"discounted_cash":34.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"K EFF BICARB 25MEQ T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000889","type":"CDM"},{"code":"259","type":"RC"},{"code":"51801000730A","type":"NDC"}],"standard_charges":[{"gross_charge":7.08,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"}]},{"description":"LACRI LUBE TUBE OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000896","type":"CDM"},{"code":"259","type":"RC"},{"code":"63736014308A","type":"NDC"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":12.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LAC RING 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500000897","type":"CDM"},{"code":"258","type":"RC"},{"code":"00264775010A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LR 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500000898","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00990795309A","type":"NDC"}],"standard_charges":[{"gross_charge":28.85,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 0.5MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000901","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035A","type":"NDC"}],"standard_charges":[{"gross_charge":31.32,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 0.125MG T","drug_information":{"unit":"0.125","type":"ME"},"code_information":[{"code":"2500000902","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268023815A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 0.25MG T","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2500000903","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378615601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIG 0.125MG/2.5ML L","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"2500000905","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054005746A","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 250MG","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500000906","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093310701A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500000911","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054829925A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500000912","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054829725","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOREPINEPHRINE I","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500000915","type":"CDM"},{"code":"250","type":"RC"},{"code":"55390000210","type":"NDC"}],"standard_charges":[{"gross_charge":41.67,"discounted_cash":16.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXID 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000920","type":"CDM"},{"code":"259","type":"RC"},{"code":"00555003305A","type":"NDC"}],"standard_charges":[{"gross_charge":6.03,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXID 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500000921","type":"CDM"},{"code":"259","type":"RC"},{"code":"00555015902A","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO 2% ABBOJ","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000927","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409490334","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARTIFICIAL TEARS OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000936","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065040872A","type":"NDC"}],"standard_charges":[{"gross_charge":108.45,"discounted_cash":43.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"DIPHENOXYLATE/ATRO","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500000941","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054319446","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENOXYLATE/ATRO T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000942","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762106101a","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"METOPROLOL 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500000943","type":"CDM"},{"code":"259","type":"RC"},{"code":"62584026601","type":"NDC"}],"standard_charges":[{"gross_charge":6.73,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARB 130MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500000955","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641047725","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROFUR 50MG C","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500000962","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268062315B","type":"NDC"}],"standard_charges":[{"gross_charge":20.97,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MGSO4 2 ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000965","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323006403A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MGSO4 2 ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500000965","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323006403B","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANNITOL 25% 50ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500000974","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409403101","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVAC 0.75% 30ML I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500000980","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409116502","type":"NDC"}],"standard_charges":[{"gross_charge":29.26,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVAC 0.75% 10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500000981","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150017110A","type":"NDC"}],"standard_charges":[{"gross_charge":35.88,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEO/POLY/DEX OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000985","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":311.49,"discounted_cash":124.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"NEO/POLY/DEX OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500000986","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":342.02,"discounted_cash":136.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"THIORIDAZINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500000995","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079056520","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARDIOPLEGIA DEL NIDO 1000ML B","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500001000","type":"CDM"},{"code":"250","type":"RC"},{"code":"69374098410A","type":"NDC"}],"standard_charges":[{"gross_charge":357.7,"discounted_cash":143.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSYLLIUM PACKET","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001009","type":"CDM"},{"code":"259","type":"RC"},{"code":"37000002404A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"SODIUM ACETATE 400MEQ/100ML VL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500001010","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323003200A","type":"NDC"}],"standard_charges":[{"gross_charge":50.94,"discounted_cash":20.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTRAXATE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500001016","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"51079067005","type":"NDC"}],"standard_charges":[{"gross_charge":32.57,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOM L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001023","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121094000A","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL L","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500001026","type":"CDM"},{"code":"259","type":"RC"},{"code":"48433020230A","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAZOSIN 1MG C","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500001027","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079063020","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCHOLINE OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001031","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208053920","type":"NDC"}],"standard_charges":[{"gross_charge":239.98,"discounted_cash":95.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILNACIPRAN 50MG","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500001037","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456155060B","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10MG/1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001038","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612725A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 400MG T","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500001043","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084065801A","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE NEB","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500001044","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030A","type":"NDC"}],"standard_charges":[{"gross_charge":31.14,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001052","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904053061A","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"Cefazolin 3g vial","drug_information":{"unit":"3","type":"GM"},"code_information":[{"code":"2500001053","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143914025","type":"NDC"}],"standard_charges":[{"gross_charge":47.6,"discounted_cash":19.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 60ML L","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2500001062","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121086802A","type":"NDC"}],"standard_charges":[{"gross_charge":63.67,"discounted_cash":25.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE 1% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001065","type":"CDM"},{"code":"259","type":"RC"},{"code":"70069012101A","type":"NDC"}],"standard_charges":[{"gross_charge":222.22,"discounted_cash":88.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"MYLANTA L","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500001067","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE 80MG T","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2500001072","type":"CDM"},{"code":"259","type":"RC"},{"code":"24385011878A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 1MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500001081","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329146901A","type":"NDC"}],"standard_charges":[{"gross_charge":100.29,"discounted_cash":40.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 0.4MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001082","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"00409121501A","type":"NDC"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":36.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPROXEN 250MG","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500001085","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268059415A","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMIPRIL 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500001087","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862047601A","type":"NDC"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.3MG T","drug_information":{"unit":"0.3","type":"ME"},"code_information":[{"code":"2500001088","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079030120A","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LETROZOLE 2.5 MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500001089","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078024915A","type":"NDC"}],"standard_charges":[{"gross_charge":137.43,"discounted_cash":54.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG VL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001099","type":"CDM"},{"code":"250","type":"RC"},{"code":"61990061102A","type":"NDC"}],"standard_charges":[{"gross_charge":118.43,"discounted_cash":47.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 2 GM IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500001100","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310511A","type":"NDC"}],"standard_charges":[{"gross_charge":69.74,"discounted_cash":27.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE 13.3 MG PATCH","drug_information":{"unit":"13.3","type":"ME"},"code_information":[{"code":"2500001102","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078050315A","type":"NDC"}],"standard_charges":[{"gross_charge":56.25,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLY/NEO/BAC TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001111","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122041405A","type":"NDC"}],"standard_charges":[{"gross_charge":29.72,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NEO/POLY/GRAM OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001112","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208079062","type":"NDC"}],"standard_charges":[{"gross_charge":208.13,"discounted_cash":83.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"POLY/NEO/BAC PACKET","drug_information":{"unit":"0.9","type":"GM"},"code_information":[{"code":"2500001113","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802014301Z","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE 25 MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500001114","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"00093901865A","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN 12.5G/50ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500001117","type":"CDM"},{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68982064301C","type":"NDC"}],"standard_charges":[{"gross_charge":326.93,"discounted_cash":130.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE 1% N","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001118","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122014903A","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"HYDROXY 10MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001119","type":"CDM"},{"code":"259","type":"RC"},{"code":"62135050247A","type":"NDC"}],"standard_charges":[{"gross_charge":9.09,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 50MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001121","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860060110A","type":"NDC"}],"standard_charges":[{"gross_charge":354.24,"discounted_cash":141.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE 10% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001122","type":"CDM"},{"code":"259","type":"RC"},{"code":"70756061430A","type":"NDC"}],"standard_charges":[{"gross_charge":138.37,"discounted_cash":55.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"PHENYLEPHRINE 10% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001122","type":"CDM"},{"code":"259","type":"RC"},{"code":"70756061430B","type":"NDC"}],"standard_charges":[{"gross_charge":138.37,"discounted_cash":55.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"PHENYLEPH 2.5% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001123","type":"CDM"},{"code":"259","type":"RC"},{"code":"70756062925A","type":"NDC"}],"standard_charges":[{"gross_charge":114.82,"discounted_cash":45.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CORVERT 1MG/10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001126","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"00009379401","type":"NDC"}],"standard_charges":[{"gross_charge":1140.26,"discounted_cash":456.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE DRIP IV","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500001127","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00409234732","type":"NDC"}],"standard_charges":[{"gross_charge":70.72,"discounted_cash":28.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 100 MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001128","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548560500A","type":"NDC"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":45.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 60MG I","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2500001129","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548560300A","type":"NDC"}],"standard_charges":[{"gross_charge":67.97,"discounted_cash":27.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOXAPINE 5 MG","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500001130","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591036901A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEALON GV PRO 15.3MG/0.85ML SY","drug_information":{"unit":"0.85","type":"ML"},"code_information":[{"code":"2500001131","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474651654A","type":"NDC"}],"standard_charges":[{"gross_charge":864.75,"discounted_cash":345.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 2.5MG C","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500001135","type":"CDM"},{"code":"259","type":"RC"},{"code":"49483022110","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 1/150GR T","drug_information":{"unit":"0.4","type":"ME"},"code_information":[{"code":"2500001139","type":"CDM"},{"code":"259","type":"RC"},{"code":"00071041824","type":"NDC"}],"standard_charges":[{"gross_charge":39.72,"discounted_cash":15.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NS 250ML IV","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500001149","type":"CDM"},{"code":"258","type":"RC"},{"code":"65219047030A","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NS 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500001150","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990798303A","type":"NDC"}],"standard_charges":[{"gross_charge":28.92,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOLUTION  IV NS 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500001151","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"00264780000A","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DISOPYRAMIDE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500001158","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093312701A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZO 200MG IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500001161","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482A","type":"NDC"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":13.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPARACAINE OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001171","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208073006A","type":"NDC"}],"standard_charges":[{"gross_charge":129.05,"discounted_cash":51.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"GUAIFEN 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500001180","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904515460","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRILAT 1.25MG/ML VL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001191","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143978710A","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC SUBSULFATE 8GM/8ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001207","type":"CDM"},{"code":"250","type":"RC"},{"code":"10481011208A","type":"NDC"}],"standard_charges":[{"gross_charge":84.05,"discounted_cash":33.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Iohexol 240mg 20ml vial","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500001220","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141220","type":"NDC"}],"standard_charges":[{"gross_charge":305.45,"discounted_cash":122.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Iohexol 240mg 10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001221","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141210A","type":"NDC"}],"standard_charges":[{"gross_charge":289.01,"discounted_cash":115.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORAL ELECTROLYTE L","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500001222","type":"CDM"},{"code":"259","type":"RC"},{"code":"24385010347A","type":"NDC"}],"standard_charges":[{"gross_charge":31.24,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEN V K 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500001230","type":"CDM"},{"code":"259","type":"RC"},{"code":"16714023401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEMANTINE","drug_information":{"unit":"28","type":"ME"},"code_information":[{"code":"2500001233","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904673561A","type":"NDC"}],"standard_charges":[{"gross_charge":94.69,"discounted_cash":37.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZALEPLON 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500001235","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054008425","type":"NDC"}],"standard_charges":[{"gross_charge":17.51,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYPROHEPTADINE 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500001244","type":"CDM"},{"code":"259","type":"RC"},{"code":"50742019001A","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE DM L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001264","type":"CDM"},{"code":"259","type":"RC"},{"code":"64679060416A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 6.25 MG/5ML UD","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001265","type":"CDM"},{"code":"259","type":"RC"},{"code":"63629915101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETH 6.25mg + COD 10MG 5ML","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001267","type":"CDM"},{"code":"259","type":"RC"},{"code":"27808006502A","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001269","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641092825A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25MG R","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500001271","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713052612","type":"NDC"}],"standard_charges":[{"gross_charge":23.82,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500001275","type":"CDM"},{"code":"259","type":"RC"},{"code":"10702000350A","type":"NDC"}],"standard_charges":[{"gross_charge":6.49,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARB 20MG/5ML L","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"2500001285","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121188450A","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN 10U I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001298","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323001211A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"K POS 5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001333","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323008605A","type":"NDC"}],"standard_charges":[{"gross_charge":28.59,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TB SKIN TEST","drug_information":{"unit":"0.1","type":"ML"},"code_information":[{"code":"2500001335","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500001336","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"00054872425","type":"NDC"}],"standard_charges":[{"gross_charge":11.81,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500001337","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054001820","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJ EST 1.25MG T","drug_information":{"unit":"0.625","type":"ME"},"code_information":[{"code":"2500001343","type":"CDM"},{"code":"259","type":"RC"},{"code":"00046110281","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROGESTERONE 50MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001363","type":"CDM"},{"code":"250","type":"RC"},{"code":"00591312879","type":"NDC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZALEPLON 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500001373","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054008525","type":"NDC"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE UP TO 0.5 MG UNITS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001380","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"71288050111A","type":"NDC"}],"standard_charges":[{"gross_charge":159.47,"discounted_cash":63.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE 250MG I","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"2500001381","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323022935","type":"NDC"}],"standard_charges":[{"gross_charge":199.91,"discounted_cash":79.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENAZOPY 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500001391","type":"CDM"},{"code":"259","type":"RC"},{"code":"42192080101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUINIDINE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500001406","type":"CDM"},{"code":"259","type":"RC"},{"code":"42806051330A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUININE 325MG C","drug_information":{"unit":"324","type":"ME"},"code_information":[{"code":"2500001408","type":"CDM"},{"code":"259","type":"RC"},{"code":"13310015307","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2MG/1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001434","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729047108A","type":"NDC"}],"standard_charges":[{"gross_charge":22.62,"discounted_cash":9.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN AC L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001438","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121177540A","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN DM L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001439","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121063800A","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE 100 MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500001441","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268075715A","type":"NDC"}],"standard_charges":[{"gross_charge":14.43,"discounted_cash":5.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SMZ/TMP L","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500001459","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121085416A","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SMZ/TMP T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001461","type":"CDM"},{"code":"259","type":"RC"},{"code":"13310014601A","type":"NDC"}],"standard_charges":[{"gross_charge":9.21,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"SILVER SULFA 50 TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001470","type":"CDM"},{"code":"259","type":"RC"},{"code":"61570013125A","type":"NDC"}],"standard_charges":[{"gross_charge":53.07,"discounted_cash":21.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"SILVER SULFA 400 TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001471","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877012440A","type":"NDC"}],"standard_charges":[{"gross_charge":226.4,"discounted_cash":90.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LEVO/CARB 10/100 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001473","type":"CDM"},{"code":"259","type":"RC"},{"code":"62756051788A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LEVO/CARB 25/100","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001474","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093970210A","type":"NDC"}],"standard_charges":[{"gross_charge":7.99,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"VICOPRPFEN T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001475","type":"CDM"},{"code":"259","type":"RC"},{"code":"53746014501A","type":"NDC"}],"standard_charges":[{"gross_charge":8.79,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"DOXEPIN 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500001476","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079043720","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500001477","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079043620","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CITALOPRAM 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500001478","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904608561A","type":"NDC"}],"standard_charges":[{"gross_charge":15.77,"discounted_cash":6.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DHE 45 I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001479","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"81284041105A","type":"NDC"}],"standard_charges":[{"gross_charge":195.64,"discounted_cash":78.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA BICARD PED I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001484","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409490014A","type":"NDC"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA BICARB ADULT I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500001485","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409663714A","type":"NDC"}],"standard_charges":[{"gross_charge":86.56,"discounted_cash":34.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE (RT) 3 ML VIAL","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500001490","type":"CDM"},{"code":"250","type":"RC"},{"code":"00487930103","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"1/2S 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500001491","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990798509A","type":"NDC"}],"standard_charges":[{"gross_charge":63.46,"discounted_cash":25.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFACETAMIDE NA OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001502","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"gross_charge":105.35,"discounted_cash":42.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"HYDROCORT 100MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500001506","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"00009001104","type":"NDC"}],"standard_charges":[{"gross_charge":69.72,"discounted_cash":27.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORT 250MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500001507","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009001306","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED 40MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001509","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00009003928A","type":"NDC"}],"standard_charges":[{"gross_charge":30.38,"discounted_cash":12.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED 125MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500001510","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00009004722A","type":"NDC"}],"standard_charges":[{"gross_charge":46.03,"discounted_cash":18.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tetanus/Diptheria TENIVAC 0.5m","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500001515","type":"CDM"},{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021515A","type":"NDC"}],"standard_charges":[{"gross_charge":214.54,"discounted_cash":85.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTORPHANOL 2MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001529","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409162601A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STER H20 20ML I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500001536","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488720","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001549","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500001550","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406577162","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOC CA 240MG C","drug_information":{"unit":"240","type":"ME"},"code_information":[{"code":"2500001572","type":"CDM"},{"code":"259","type":"RC"},{"code":"41167061002A","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LTHYROXINE 0.1MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001581","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079044220","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"AMANTADINE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500001584","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904704261A","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIMETIDINE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500001589","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378005301a","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTAZOCINE/NALOX T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001593","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591039501A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CARBAMAZEPIN 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500001603","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904617261A","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE 1/2% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001623","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065074114A","type":"NDC"}],"standard_charges":[{"gross_charge":54.96,"discounted_cash":21.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"TETRACYCLINE 250MG C","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500001625","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155001701A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZIN 25MG","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500001640","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904713061A","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZIN 50MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500001651","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":188.53,"discounted_cash":75.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN 5000 U TOP","drug_information":{"unit":"5000","type":"UN"},"code_information":[{"code":"2500001652","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793021505","type":"NDC"}],"standard_charges":[{"gross_charge":408.75,"discounted_cash":163.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THYROID 1 GM T","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500001654","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456045901","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL 0.25% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001660","type":"CDM"},{"code":"259","type":"RC"},{"code":"60758080205A","type":"NDC"}],"standard_charges":[{"gross_charge":117.61,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"TIMOPTIC 0.5% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001662","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314022705A","type":"NDC"}],"standard_charges":[{"gross_charge":139.83,"discounted_cash":55.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"IMIPRAMINE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500001667","type":"CDM"},{"code":"259","type":"RC"},{"code":"69584042610A","type":"NDC"}],"standard_charges":[{"gross_charge":18.55,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM ER 60 MG CAP","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500001670","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378606001A","type":"NDC"}],"standard_charges":[{"gross_charge":8.74,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLORAZEPATE 3.75MG T","drug_information":{"unit":"3.75","type":"ME"},"code_information":[{"code":"2500001681","type":"CDM"},{"code":"259","type":"RC"},{"code":"13107031901A","type":"NDC"}],"standard_charges":[{"gross_charge":14.67,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHEN/AMI 2/25 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001690","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378044201","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"TUCKS TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001700","type":"CDM"},{"code":"250","type":"RC"},{"code":"41388000730A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE/CHLOR L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001704","type":"CDM"},{"code":"259","type":"RC"},{"code":"27808008602A","type":"NDC"}],"standard_charges":[{"gross_charge":17.09,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMIN 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500001708","type":"CDM"},{"code":"259","type":"RC"},{"code":"51645070510A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMIN 160MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001709","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121065705","type":"NDC"}],"standard_charges":[{"gross_charge":14.81,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMIN 325MG T","drug_information":{"unit":"325","type":"ME"},"code_information":[{"code":"2500001711","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904677361A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN #3 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001712","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406048462","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"ACETAMIN/COD 5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001714","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121050440A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAMETH VAL 0.1 TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001731","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168004015","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"DIAZEPAM 10MG/2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500001736","type":"CDM"},{"code":"250","type":"RC"},{"code":"69339013634A","type":"NDC"}],"standard_charges":[{"gross_charge":50.31,"discounted_cash":20.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500001737","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079028420","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500001738","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079028520A","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASELINE 1OZ TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001745","type":"CDM"},{"code":"259","type":"RC"},{"code":"08884430200A","type":"NDC"}],"standard_charges":[{"gross_charge":12.2,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"PEN VK 250/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500001759","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093412773","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXY PAM 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500001769","type":"CDM"},{"code":"259","type":"RC"},{"code":"00185067401A","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXY PAM 50MG C","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500001770","type":"CDM"},{"code":"250","type":"RC"},{"code":"00185067601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STER H2O IRR 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500001795","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264210100A","type":"NDC"}],"standard_charges":[{"gross_charge":52.93,"discounted_cash":21.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALURONIDASE 150U I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001808","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657011704C","type":"NDC"}],"standard_charges":[{"gross_charge":317.81,"discounted_cash":127.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO 1% EPI VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500001810","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048227A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO 2% 10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500001813","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409428202A","type":"NDC"}],"standard_charges":[{"gross_charge":32.84,"discounted_cash":13.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO VISCOUS L","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500001817","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121495040A","type":"NDC"}],"standard_charges":[{"gross_charge":17.88,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 5% TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001819","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168020437","type":"NDC"}],"standard_charges":[{"gross_charge":78.97,"discounted_cash":31.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ALLOPURINOL 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500001833","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079020620","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALLOPURINOL 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500001835","type":"CDM"},{"code":"259","type":"RC"},{"code":"16729013401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORITAVANCIN 400 MG VIAL","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500001856","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2407","type":"HCPCS"},{"code":"70842014003A","type":"NDC"}],"standard_charges":[{"gross_charge":2715.79,"discounted_cash":1086.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACUBITRIL/VALSARTAN 24MG/26MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500001857","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078065920","type":"NDC"}],"standard_charges":[{"gross_charge":35.6,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"TERBUTALINE 1MG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500001877","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMIN 650MG R","drug_information":{"unit":"650","type":"ME"},"code_information":[{"code":"2500001880","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802073030A","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOTALOL 80MG T","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2500001905","type":"CDM"},{"code":"259","type":"RC"},{"code":"76385011401A","type":"NDC"}],"standard_charges":[{"gross_charge":15.57,"discounted_cash":6.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Epinephrine 10mg/10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500002001","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288012001A","type":"NDC"}],"standard_charges":[{"gross_charge":429.43,"discounted_cash":171.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RECOMBINANT 20,000U VL","drug_information":{"unit":"20000","type":"UN"},"code_information":[{"code":"2500002102","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338032601A","type":"NDC"}],"standard_charges":[{"gross_charge":1740.47,"discounted_cash":696.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Plasma-lyte Ph 7.4 1000ml bag","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500002104","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338022104B","type":"NDC"}],"standard_charges":[{"gross_charge":83.81,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lidocaine 2% 50ml MDV","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500002150","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143957510A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL 5MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500002207","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401A","type":"NDC"}],"standard_charges":[{"gross_charge":34.3,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Indocyanine Green 25 mg vial","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500002299","type":"CDM"},{"code":"250","type":"RC"},{"code":"70100042402A","type":"NDC"}],"standard_charges":[{"gross_charge":503.06,"discounted_cash":201.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Clinimix 5/15 E 2L bag","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500002304","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338112304A","type":"NDC"}],"standard_charges":[{"gross_charge":387.21,"discounted_cash":154.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLOPATADINE NASAL SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500002429","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505084505A","type":"NDC"}],"standard_charges":[{"gross_charge":680.68,"discounted_cash":272.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"LURASIDONE 20 MG TAB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500002430","type":"CDM"},{"code":"259","type":"RC"},{"code":"63402030230A","type":"NDC"}],"standard_charges":[{"gross_charge":146.1,"discounted_cash":58.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZONATATE 200 MG CAPS","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500002431","type":"CDM"},{"code":"259","type":"RC"},{"code":"57664013488A","type":"NDC"}],"standard_charges":[{"gross_charge":9.4,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZONISAMIDE 50 MG CAPS","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500002439","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462012901A","type":"NDC"}],"standard_charges":[{"gross_charge":52.02,"discounted_cash":20.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 800 MG TAB","drug_information":{"unit":"800","type":"ME"},"code_information":[{"code":"2500002440","type":"CDM"},{"code":"259","type":"RC"},{"code":"68382043528A","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lido w/ Epi 2% 1:100,000 50ml","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500002502","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409318231A","type":"NDC"}],"standard_charges":[{"gross_charge":25.47,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D51/2S 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500002813","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990792609A","type":"NDC"}],"standard_charges":[{"gross_charge":68.86,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5LR 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500002814","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990792909A","type":"NDC"}],"standard_charges":[{"gross_charge":78.55,"discounted_cash":31.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500002827","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054001720","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500002830","type":"CDM"},{"code":"259","type":"RC"},{"code":"62332002531A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500002831","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904585461A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFACLOR 250MG C","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500002832","type":"CDM"},{"code":"259","type":"RC"},{"code":"61442017130A","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE 250 MG CAP","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500002901","type":"CDM"},{"code":"259","type":"RC"},{"code":"00004025901A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLESTIPOL HC1 1G TAB","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500003010","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762045001A","type":"NDC"}],"standard_charges":[{"gross_charge":6.21,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DELESTROG 20MGML INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003076","type":"CDM"},{"code":"636","type":"RC"},{"code":"42023011101","type":"NDC"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":121.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE PF 10MG/ML VIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003147","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125A","type":"NDC"}],"standard_charges":[{"gross_charge":29.84,"discounted_cash":11.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APIXABAN 2.5MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500003471","type":"CDM"},{"code":"259","type":"RC"},{"code":"00003089331","type":"NDC"}],"standard_charges":[{"gross_charge":23.78,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULF 4GM/100ML IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500003475","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042124A","type":"NDC"}],"standard_charges":[{"gross_charge":34.31,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APIXABAN 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500003480","type":"CDM"},{"code":"259","type":"RC"},{"code":"00003089421A","type":"NDC"}],"standard_charges":[{"gross_charge":23.78,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFEN 100MG/5ML L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500003593","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121148800A","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LTHYROXINE 0.15MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003594","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079044520","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"THIAMINE 100MG/ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500003602","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":56.67,"discounted_cash":22.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA CL BACT 30ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500003605","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409196607A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA BICARB INFANT I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500003606","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409553414A","type":"NDC"}],"standard_charges":[{"gross_charge":53.26,"discounted_cash":21.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHENAMINE COMBO T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003607","type":"CDM"},{"code":"259","type":"RC"},{"code":"00485015130A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002143380A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.5","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002143480A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002144511A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002150680A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002448354A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002449108A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002840001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002882427A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003037113A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003085222A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00003362212A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006008131A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006033530A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006302602B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006307401A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006500701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006502901A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006505506A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006536403A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00008122201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00019086250A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023650110A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00024576105A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00024591401A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00046110511A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00049233045A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054007928A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054017713A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065414727A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069015111A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069018921A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069019301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069024430A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069024430B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069098038A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069100201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069504530A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069814020A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00069873001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00071052524A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074003828A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074055402A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074057611A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074105001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074230630A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074262528A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074301207A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074433902A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074433902a","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074709530A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078056651A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078060715A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078063941A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078065615A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078067119A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078068166A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078068515A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078070184A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078100060B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078107766A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078111215A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00085432402A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093312298A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093365940A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093550756A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093766256A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093790901A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093821062A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00093874001","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121064616A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00131247835A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168004160A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168005615A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169255097A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169266015A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169291115A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169406012A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.2","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169418113A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169430330A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"100","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173088101B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173088714B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00186077660A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00187520030H","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00187552675A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00245036030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270111102A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270111103A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270111104A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270131525A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270131535A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270131635A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00270141111A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310066860A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310111039A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310134930A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310134930B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310173030B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310351260A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310461639A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310620530E","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00310626060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378170777A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378326694A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378336099A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378696112A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378932032A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00406880801A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456111030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456120330A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456122830A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456155060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456228030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00456241060F","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00469012599A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00469260230A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00469266030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00527139601A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00555901058A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00555904558A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00555904558B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00555906458A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574029201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00591040401A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00591041401a","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597003510A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597010860A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597014560A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597015337A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597015570B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597016439A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597028073A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00603254021A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703367101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00713033915A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781543901","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781801731A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781802931A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00832107130A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904721304B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"00944270006B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"10144034201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"700","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"10361077831A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"11523432601A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"11845014028A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668045301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571069101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714036304A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729014201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729029212A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"17772012301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922005351A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155011701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155053201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208037705A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050402A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050707A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208060203A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208069762A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091112A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510014010A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24571010306A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"24571010506A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722001490A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722086903A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"148","type":"GM"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909010510A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909011600A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909012107A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"750","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909016755A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909074603B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"176","type":"GM"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909075003A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"340","type":"GM"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909076401A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"32909092703A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342004710A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342004910A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"35046000751A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000029417A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565012249A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192032701a","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291006930A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"42388002426A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"42388002526A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"42747060290A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799011201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806008701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068010602A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"43353084130A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386048024A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"43538095104A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547029903A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"500","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598012811A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975030810A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802035165A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802039000A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802057884B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335017149A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335017795B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335017795C","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335047583A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335083683B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781010444A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781060730A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49230064551A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49401010101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49401010201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483022310A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502080693A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702022318A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702023113A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702024213A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702024613A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884034701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884048711A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884054601A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242009002A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242012101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242012206A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242012301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242013001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242015001","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242022701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242071701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268008612B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268014415A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268017213A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268033212A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268057112A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268062315A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268071813B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268073813A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419017106A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419025201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419025491A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419039501A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419040903A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419054001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419054001B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458030811A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056301","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056401","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058601A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474057009A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080103A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580072812A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742011201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50881001560A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"50991012116A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079020120A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51144000212A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51167033101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51167054830A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224010150A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51267089099A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672139500A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404401A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759020210A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759020410A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.28","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759052010A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.35","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759063010A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.56","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759085010A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.7","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759096010A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51801001330A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991007401A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991062328A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991081390A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536088601A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817027110A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817083004A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"52937000120A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092051902A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092054701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111025860A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111042830A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111066130A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55494012060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55494058090A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513013760A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513071021A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513081060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513084301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566830301J","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"55724021121A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57844012001C","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894003001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894005427A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"26","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894005427C","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894015012A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57962001428","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57962028028A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"58406002104A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468021004A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468784003A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148001871A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003713A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148010280A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"3.2","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148011480A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148024512A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59316010212A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"17","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59338077501A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002360A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"0.2","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385004130A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010310A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572021015A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572040228A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572050221A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572071030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651006605A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676056201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676057530A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676060012A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762011901A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"59922063101B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505083305A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505437403A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"60631004030F","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"60631042530E","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687015501A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687021625A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687034425A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002002A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002102A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874010008A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874013020A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958080101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958170101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958200201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958210101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958220101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332000831A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332014060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332023504A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332024590A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62541040310A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559073001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756014301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856040530A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856070405A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"63020023002A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"63020053630A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"63090034030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402020660A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402031230A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253011130A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380091806A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64406000602A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64406001101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764025030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764030020A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764075030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896008412G","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65038056199A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080810A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65597020230A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649000330A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649015090A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757040203A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"3.2","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757040303A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"3.9","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757040403A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757050003A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862014836A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862020768A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862092730A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862092836A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66215050115A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66215050130A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66215061606A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66302032502A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66658023407A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758008675A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66794015601A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66983035020A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993082130A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"67386013051A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001024200A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001024515A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001025001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68135005890A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015701A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180016713A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180065906B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180090273A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308075030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382075016A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013281A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462030450A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546017060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682010301A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682035710A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68992301003A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097043202A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"69516000530A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"69547035302A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"69616027230A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"69880012028A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70127010001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70127010001B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70255001002A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70255002501A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70301100201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70301100201B","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370108001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436010109A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70539000102A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700011385A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700011585A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700011985A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700030385A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700030785A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70727049725A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756070230A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842024001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860045310A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"71149000001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699005030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858004004A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72060014230A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72426011803A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72426081803A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72482010012A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72511075001A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578012008A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72579001102A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603024601A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72694061760A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"72819016203A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"73154013060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"73336007530A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"73556016801A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011401A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834012929A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907008262A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385010201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012501A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206014603A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"79802020030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"80610043060A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"81520010030A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"81864010330A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"81942012501A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"81968035101A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584060930A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"82625880201A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISCELLANEOUS RX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003618","type":"CDM"},{"code":"250","type":"RC"},{"code":"87651076011A","type":"NDC"}],"standard_charges":[{"gross_charge":77.53,"discounted_cash":31.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERY ETH 200MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500003641","type":"CDM"},{"code":"259","type":"RC"},{"code":"24338013402","type":"NDC"}],"standard_charges":[{"gross_charge":6.08,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500003678","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"00603459315","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROGESTERONE 100MG PO","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500003701","type":"CDM"},{"code":"259","type":"RC"},{"code":"70700016201A","type":"NDC"}],"standard_charges":[{"gross_charge":9.96,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EFAVIR 600MG","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500003708","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862004930A","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE 20MG I","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2500003709","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023012306","type":"NDC"}],"standard_charges":[{"gross_charge":406.33,"discounted_cash":162.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TET & DIPTH I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500003719","type":"CDM"},{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021510A","type":"NDC"}],"standard_charges":[{"gross_charge":146.98,"discounted_cash":58.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500003735","type":"CDM"},{"code":"259","type":"RC"},{"code":"67405065155A","type":"NDC"}],"standard_charges":[{"gross_charge":29.42,"discounted_cash":11.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM 90 MG CAPSULE","drug_information":{"unit":"90","type":"ME"},"code_information":[{"code":"2500003786","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378609001A","type":"NDC"}],"standard_charges":[{"gross_charge":14.96,"discounted_cash":5.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPIFOAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003806","type":"CDM"},{"code":"250","type":"RC"},{"code":"00037682410","type":"NDC"}],"standard_charges":[{"gross_charge":99.56,"discounted_cash":39.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"KCL MICRO 20MEQ T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003816","type":"CDM"},{"code":"259","type":"RC"},{"code":"00245531901A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"TAMOXIFEN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500003829","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739014310A","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 20MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500003841","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 100/4 L","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500003850","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672406902A","type":"NDC"}],"standard_charges":[{"gross_charge":9.17,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONID 500MG IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500003853","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021013182A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHHYLENE BLUE I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500003854","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288014701A","type":"NDC"}],"standard_charges":[{"gross_charge":46.31,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRENATAL VITAMIN T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003863","type":"CDM"},{"code":"259","type":"RC"},{"code":"13811000710","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CEFACLOR 250/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500003867","type":"CDM"},{"code":"259","type":"RC"},{"code":"16571007112A","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Phenylephrine 20mg/250ml","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500003870","type":"CDM"},{"code":"250","type":"RC"},{"code":"70092904205A","type":"NDC"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500003884","type":"CDM"},{"code":"250","type":"RC"},{"code":"5464356491","type":"NDC"}],"standard_charges":[{"gross_charge":115.14,"discounted_cash":46.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA BICARB VIAL I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500003886","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754500104A","type":"NDC"}],"standard_charges":[{"gross_charge":42.28,"discounted_cash":16.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA BICARB VIAL I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500003886","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754500105A","type":"NDC"}],"standard_charges":[{"gross_charge":42.28,"discounted_cash":16.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE 2% I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500003888","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047637A","type":"NDC"}],"standard_charges":[{"gross_charge":75.46,"discounted_cash":30.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOTAXIME 1GM IVPB","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500003892","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409359511B","type":"NDC"}],"standard_charges":[{"gross_charge":57.89,"discounted_cash":23.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE NIT TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500003913","type":"CDM"},{"code":"250","type":"RC"},{"code":"00536113428A","type":"NDC"}],"standard_charges":[{"gross_charge":25.01,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"SODIUM CHLORIDE 14.6%40ML VIAL","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"2500003940","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323013940A","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMAZEPAM 15MG C","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500003943","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079041820","type":"NDC"}],"standard_charges":[{"gross_charge":55.43,"discounted_cash":22.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500003944","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409114405A","type":"NDC"}],"standard_charges":[{"gross_charge":55.62,"discounted_cash":22.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RACEPINEPHRINE INHS","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500003954","type":"CDM"},{"code":"250","type":"RC"},{"code":"00487590199","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN 5000 U/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500003978","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641040012A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL 20MEQ L","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500003989","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121494840A","type":"NDC"}],"standard_charges":[{"gross_charge":74.11,"discounted_cash":29.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMID 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500004000","type":"CDM"},{"code":"259","type":"RC"},{"code":"62559016601A","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 80MG T","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2500004008","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054830125A","type":"NDC"}],"standard_charges":[{"gross_charge":17.09,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 20MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500004009","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"00409610202A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 40MG I","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500004010","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204A","type":"NDC"}],"standard_charges":[{"gross_charge":29.26,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMID 40MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500004011","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094086762A","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 125MG I","drug_information":{"unit":"125","type":"ME"},"code_information":[{"code":"2500004012","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781940195A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIAN 250MG I","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500004013","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781940295","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500004020","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904722961A","type":"NDC"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOPHYLLIN 500MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500004040","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500004063","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094000162A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 0.25MG T","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2500004064","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079078820A","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lidocaine 1% PF 10ml vl","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500004071","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049297A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500004090","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338100503A","type":"NDC"}],"standard_charges":[{"gross_charge":227.43,"discounted_cash":90.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500004094","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338040903A","type":"NDC"}],"standard_charges":[{"gross_charge":30.15,"discounted_cash":12.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIFLUNISAL 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500004096","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093922206","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANAGLIFLOZIN 100 MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500004103","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458014030A","type":"NDC"}],"standard_charges":[{"gross_charge":74.37,"discounted_cash":29.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN D 5000 UNIT TAB","drug_information":{"unit":"5000","type":"UN"},"code_information":[{"code":"2500004104","type":"CDM"},{"code":"259","type":"RC"},{"code":"87701040752A","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 0.2MG PATCH","drug_information":{"unit":"0.2","type":"ME"},"code_information":[{"code":"2500004122","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378910493A","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 0.1MG PATCH","drug_information":{"unit":"0.1","type":"ME"},"code_information":[{"code":"2500004123","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378910293","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500004133","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567070625A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 1GM I","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500004134","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00781345196A","type":"NDC"}],"standard_charges":[{"gross_charge":30.11,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBAMYCIN 80MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500004138","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322Z","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMILORID/HCTZ 5/50 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004144","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378057701A","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"SUCRALFATE 1GRAM T","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500004145","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079075320A","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D51/2NS 20KCL 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500004147","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990790209A","type":"NDC"}],"standard_charges":[{"gross_charge":98.86,"discounted_cash":39.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN 40 MG TAB","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500004158","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078042315A","type":"NDC"}],"standard_charges":[{"gross_charge":20.53,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500004184","type":"CDM"},{"code":"259","type":"RC"},{"code":"69238134501A","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALDOPERIDOL 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2500004202","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079073320","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIROXICAM 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500004208","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093075601A","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODONE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500004234","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904686861A","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERPAMIL 80MG T","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2500004236","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155002601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COCAINE 4% 4ML TOP","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500004250","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9046","type":"HCPCS"},{"code":"64950036204A","type":"NDC"}],"standard_charges":[{"gross_charge":1221.82,"discounted_cash":488.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAZOLAM 0.25MG T","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2500004289","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762371804A","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEO/POLY GU I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500004290","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822120105A","type":"NDC"}],"standard_charges":[{"gross_charge":57.38,"discounted_cash":22.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500004304","type":"CDM"},{"code":"259","type":"RC"},{"code":"00143117201A","type":"NDC"}],"standard_charges":[{"gross_charge":8.02,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500004314","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781169501A","type":"NDC"}],"standard_charges":[{"gross_charge":9.02,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO UROJECT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004321","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021067377A","type":"NDC"}],"standard_charges":[{"gross_charge":51.12,"discounted_cash":20.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORTHALIDON 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500004325","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378022210A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE SODIUM 50MG CAP","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500004333","type":"CDM"},{"code":"259","type":"RC"},{"code":"00115442201A","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25MG I","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500004336","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748032310A","type":"NDC"}],"standard_charges":[{"gross_charge":29.36,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500004337","type":"CDM"},{"code":"259","type":"RC"},{"code":"00185012901A","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lip Balm","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004349","type":"CDM"},{"code":"259","type":"RC"},{"code":"2500004349A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"DEXTROSE 10% 250 ML BAG","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500004354","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264752020A","type":"NDC"}],"standard_charges":[{"gross_charge":65.74,"discounted_cash":26.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10% 250 ML BAG","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500004354","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323082475A","type":"NDC"}],"standard_charges":[{"gross_charge":65.74,"discounted_cash":26.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALBUPHINE 10MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500004360","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"00409146301","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOCONAZOLE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500004390","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672402606","type":"NDC"}],"standard_charges":[{"gross_charge":21.26,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500004392","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093075201A","type":"NDC"}],"standard_charges":[{"gross_charge":8.19,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL CR 8MEQ C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004396","type":"CDM"},{"code":"259","type":"RC"},{"code":"70010002101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MEQ"}]},{"description":"SENNA T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004399","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904725261A","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"DOXYLAMINE SUCCINATE 25MG","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500004401","type":"CDM"},{"code":"259","type":"RC"},{"code":"00363044167A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIDAXOMICIN 200MG","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500004402","type":"CDM"},{"code":"259","type":"RC"},{"code":"52015008001","type":"NDC"}],"standard_charges":[{"gross_charge":797.37,"discounted_cash":318.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lidocaine 1.5% / Epinephrine 1","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500004403","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409120901A","type":"NDC"}],"standard_charges":[{"gross_charge":30.49,"discounted_cash":12.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lidocaine 1.5% / Epinephrine 1","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500004404","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048817A","type":"NDC"}],"standard_charges":[{"gross_charge":47.27,"discounted_cash":18.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEMA14C","drug_information":{"unit":"14","type":"ME"},"code_information":[{"code":"2500004408","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180024706A","type":"NDC"}],"standard_charges":[{"gross_charge":33.57,"discounted_cash":13.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA CITRATE 15ML L","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500004411","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121059515","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL STERILE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500004445","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025410","type":"NDC"}],"standard_charges":[{"gross_charge":29.38,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 300MG C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500004487","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180065906A","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BROMO MES 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500004488","type":"CDM"},{"code":"259","type":"RC"},{"code":"63304096230A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER WOUND GEL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004509","type":"CDM"},{"code":"250","type":"RC"},{"code":"80196029660A","type":"NDC"}],"standard_charges":[{"gross_charge":145.06,"discounted_cash":58.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LIDOCAINE 4% TOP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500004521","type":"CDM"},{"code":"250","type":"RC"},{"code":"00054350547","type":"NDC"}],"standard_charges":[{"gross_charge":306.79,"discounted_cash":122.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500004523","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079074520","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOCINOLONE 0.9% OTIC 20 ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004545","type":"CDM"},{"code":"250","type":"RC"},{"code":"68791010320a","type":"NDC"}],"standard_charges":[{"gross_charge":410.96,"discounted_cash":164.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"NAMENDA XR 7MG","drug_information":{"unit":"7","type":"ME"},"code_information":[{"code":"2500004546","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456340733A","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAMENDA XR 21MG","drug_information":{"unit":"21","type":"ME"},"code_information":[{"code":"2500004547","type":"CDM"},{"code":"259","type":"RC"},{"code":"59651040630A","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 8MG T","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2500004548","type":"CDM"},{"code":"259","type":"RC"},{"code":"42858030301A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALEVE 220MG T","drug_information":{"unit":"220","type":"ME"},"code_information":[{"code":"2500004561","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802049075A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN 80MG C","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2500004562","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078035834A","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERAZOSIN 2MG C","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500004563","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079093720","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDARUCIZUMAB 2.5GM/50ML VIAL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500004580","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597019705","type":"NDC"}],"standard_charges":[{"gross_charge":3562.0,"discounted_cash":1424.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECURONIUM 10MG I","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500004705","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023510A","type":"NDC"}],"standard_charges":[{"gross_charge":29.53,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOCAINE SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004723","type":"CDM"},{"code":"250","type":"RC"},{"code":"00283067960","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":9.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"Baricitinib 1mg tab EUA","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500004732","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002473230A","type":"NDC"}],"standard_charges":[{"gross_charge":452.63,"discounted_cash":181.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Baricitinib 2mg tab EUA","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500004733","type":"CDM"},{"code":"250","type":"RC"},{"code":"00002418230A","type":"NDC"}],"standard_charges":[{"gross_charge":452.18,"discounted_cash":180.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500004773","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093936401A","type":"NDC"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 100MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500004774","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143962201A","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10MG","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500004780","type":"CDM"},{"code":"259","type":"RC"},{"code":"00310621039A","type":"NDC"}],"standard_charges":[{"gross_charge":65.11,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 30MG","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500004790","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884000901A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLON/BENZ OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004914","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":117.76,"discounted_cash":47.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"ERYTHROMYCIN OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500004915","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574402435","type":"NDC"}],"standard_charges":[{"gross_charge":85.25,"discounted_cash":34.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NITRO DRIP 250ML IV","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500004983","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338104702A","type":"NDC"}],"standard_charges":[{"gross_charge":37.58,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATIVAN INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500004991","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604425F","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUFENTANIL 1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500004992","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409338049","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APIXABAN 2.5MG TAB","drug_information":{"unit":"750","type":"ME"},"code_information":[{"code":"2500005001","type":"CDM"},{"code":"259","type":"RC"},{"code":"00409653101","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE/FORMOTEROL INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005036","type":"CDM"},{"code":"259","type":"RC"},{"code":"00310460012A","type":"NDC"}],"standard_charges":[{"gross_charge":1252.56,"discounted_cash":501.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"FLUTICASONE FUORATE ELLIPTA IN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005037","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173087414A","type":"NDC"}],"standard_charges":[{"gross_charge":34.73,"discounted_cash":13.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"OLODATEROL RESPIMAT INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005039","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597019261A","type":"NDC"}],"standard_charges":[{"gross_charge":983.99,"discounted_cash":393.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"TIOTROPIUM BROMIDE RESPIMAT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005040","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597010051A","type":"NDC"}],"standard_charges":[{"gross_charge":427.16,"discounted_cash":170.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"DILTIAZEM 60MG T","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500005078","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079074620","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL 12.5MG T","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2500005079","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079086320","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 500MG","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500005088","type":"CDM"},{"code":"259","type":"RC"},{"code":"00143993905A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EMPAGLIFLOZIN 25MG TAB","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500005099","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597015390A","type":"NDC"}],"standard_charges":[{"gross_charge":87.58,"discounted_cash":35.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERITONEAL DIALYSATE 1.5% 6L","drug_information":{"unit":"6000","type":"ML"},"code_information":[{"code":"2500005109","type":"CDM"},{"code":"250","type":"RC"},{"code":"00941040901B","type":"NDC"}],"standard_charges":[{"gross_charge":100.72,"discounted_cash":40.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERITONEAL DIALYSATE 2.5% 6L","drug_information":{"unit":"6000","type":"ML"},"code_information":[{"code":"2500005110","type":"CDM"},{"code":"250","type":"RC"},{"code":"00941045701B","type":"NDC"}],"standard_charges":[{"gross_charge":113.45,"discounted_cash":45.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERITONEAL DIALYSATE 4.25% 6L","drug_information":{"unit":"6000","type":"ML"},"code_information":[{"code":"2500005111","type":"CDM"},{"code":"250","type":"RC"},{"code":"00941045901B","type":"NDC"}],"standard_charges":[{"gross_charge":113.45,"discounted_cash":45.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IV 7929 D5 LR 500CC","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500005137","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990792903A","type":"NDC"}],"standard_charges":[{"gross_charge":39.36,"discounted_cash":15.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE 3% I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500005148","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047827A","type":"NDC"}],"standard_charges":[{"gross_charge":105.35,"discounted_cash":42.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROPRUSSIDE 50MG I","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500005157","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069026101A","type":"NDC"}],"standard_charges":[{"gross_charge":118.66,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE 250MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500005160","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00409234402A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500005161","type":"CDM"},{"code":"259","type":"RC"},{"code":"43547054610A","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUM HYDROX/MAG TRISIL 15ML UD","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500005164","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904772714","type":"NDC"}],"standard_charges":[{"gross_charge":35.12,"discounted_cash":14.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 1GM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500005173","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00781320895A","type":"NDC"}],"standard_charges":[{"gross_charge":110.72,"discounted_cash":44.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 1GM IVPB","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500005174","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781320895B","type":"NDC"}],"standard_charges":[{"gross_charge":197.96,"discounted_cash":79.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM 500MG IVPB","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500005175","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006351659A","type":"NDC"}],"standard_charges":[{"gross_charge":158.59,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HBIG 1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500005176","type":"CDM"},{"code":"250","type":"RC"},{"code":"69800420201A","type":"NDC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIOTROPIUM/OLODATEROL INHALER","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005209","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597015570A","type":"NDC"}],"standard_charges":[{"gross_charge":1700.25,"discounted_cash":680.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"LIDO 0.5% 50ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500005260","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409427801A","type":"NDC"}],"standard_charges":[{"gross_charge":40.52,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO 0.5% 50ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500005260","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":40.52,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPHEDRINE I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500005261","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023021625A","type":"NDC"}],"standard_charges":[{"gross_charge":250.51,"discounted_cash":100.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HETASTARCH 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500005262","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409724803A","type":"NDC"}],"standard_charges":[{"gross_charge":71.44,"discounted_cash":28.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMINE 2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005264","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781304095","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":26.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACA EPI 0.25% 30ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500005273","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046837A","type":"NDC"}],"standard_charges":[{"gross_charge":37.97,"discounted_cash":15.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENTOLAMINE MES UP TO 5 MG UN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005274","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"00143956401A","type":"NDC"}],"standard_charges":[{"gross_charge":888.63,"discounted_cash":355.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLERGONOVINE UP TO 0.2 MG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500005275","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"00517074020A","type":"NDC"}],"standard_charges":[{"gross_charge":154.47,"discounted_cash":61.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACA EPI 0.5% 30 ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500005343","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409904517","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":13.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN 100U/ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500005345","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253033335A","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN 1000 U/ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500005346","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054011","type":"NDC"}],"standard_charges":[{"gross_charge":41.06,"discounted_cash":16.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 5MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500005349","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409230550","type":"NDC"}],"standard_charges":[{"gross_charge":29.37,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED 1000MG I","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500005351","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009069801","type":"NDC"}],"standard_charges":[{"gross_charge":161.99,"discounted_cash":64.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 1MG/ML 100ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500005353","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70004041136","type":"NDC"}],"standard_charges":[{"gross_charge":118.66,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEO SYNEPHRINE 1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500005357","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":13.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRIN 0.25% N","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005358","type":"CDM"},{"code":"250","type":"RC"},{"code":"00225080047A","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"METHOHEXITAL 500MG I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500005363","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010501","type":"NDC"}],"standard_charges":[{"gross_charge":244.52,"discounted_cash":97.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE 20MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005364","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288012710A","type":"NDC"}],"standard_charges":[{"gross_charge":44.44,"discounted_cash":17.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROSCAR 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500005367","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093735505A","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":6.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYC 900MG IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500005430","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781329009A","type":"NDC"}],"standard_charges":[{"gross_charge":166.97,"discounted_cash":66.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFADROXIL 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500005432","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180018008","type":"NDC"}],"standard_charges":[{"gross_charge":44.99,"discounted_cash":18.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D51/4NS 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500005435","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990792402","type":"NDC"}],"standard_charges":[{"gross_charge":57.91,"discounted_cash":23.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 650 TAB","drug_information":{"unit":"650","type":"ME"},"code_information":[{"code":"2500005444","type":"CDM"},{"code":"259","type":"RC"},{"code":"69918030130A","type":"NDC"}],"standard_charges":[{"gross_charge":20.65,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMTERENE 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500005493","type":"CDM"},{"code":"259","type":"RC"},{"code":"59212000201A","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL 1.25 INH","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500005511","type":"CDM"},{"code":"259","type":"RC"},{"code":"76204090001A","type":"NDC"}],"standard_charges":[{"gross_charge":52.11,"discounted_cash":20.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE UD","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500005514","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729052608B","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR 30 MG CAP","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500005521","type":"CDM"},{"code":"259","type":"RC"},{"code":"00004080285A","type":"NDC"}],"standard_charges":[{"gross_charge":67.31,"discounted_cash":26.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LUGOLS SOLUTION 30ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005530","type":"CDM"},{"code":"250","type":"RC"},{"code":"48433023015A","type":"NDC"}],"standard_charges":[{"gross_charge":8.63,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER NITRATE STICK","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005531","type":"CDM"},{"code":"250","type":"RC"},{"code":"12870000102A","type":"NDC"}],"standard_charges":[{"gross_charge":14.72,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 200MG PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500005535","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338955524A","type":"NDC"}],"standard_charges":[{"gross_charge":141.24,"discounted_cash":56.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE 2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005536","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409341411A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 1GM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500005540","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567023525B","type":"NDC"}],"standard_charges":[{"gross_charge":29.41,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACTAM ER T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500005541","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505328006A","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOMIDATE 20ML I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500005543","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266014710A","type":"NDC"}],"standard_charges":[{"gross_charge":143.44,"discounted_cash":57.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIM/BETAMETH TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005544","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":171.11,"discounted_cash":68.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"BUPRENORPHIN 0.3MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500005545","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409201232A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500005568","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904552987A","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500005569","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079096620A","type":"NDC"}],"standard_charges":[{"gross_charge":9.64,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SMZ/TMP 5ML IVPB","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500005570","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703950303","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE PATCH 1","drug_information":{"unit":"0.1","type":"ME"},"code_information":[{"code":"2500005574","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378087199A","type":"NDC"}],"standard_charges":[{"gross_charge":174.85,"discounted_cash":69.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUDROCORT 0.1MG T","drug_information":{"unit":"0.1","type":"ME"},"code_information":[{"code":"2500005575","type":"CDM"},{"code":"259","type":"RC"},{"code":"00115703301","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMI 5MG/5ML L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500005577","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121157610","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL 100MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500005578","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019011501","type":"NDC"}],"standard_charges":[{"gross_charge":109.12,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPER 25MG R","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500005579","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713013512","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN D L","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005580","type":"CDM"},{"code":"259","type":"RC"},{"code":"69367028302A","type":"NDC"}],"standard_charges":[{"gross_charge":344.98,"discounted_cash":137.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"LABETALOL 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500005605","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079092920","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTOXIFYL 400MG T","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500005609","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904544861A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUSPIRONE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500005611","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378114001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE 7 V","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005618","type":"CDM"},{"code":"259","type":"RC"},{"code":"24385059029A","type":"NDC"}],"standard_charges":[{"gross_charge":37.04,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NORTRIPTYLINE 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500005619","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406991103A","type":"NDC"}],"standard_charges":[{"gross_charge":42.08,"discounted_cash":16.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005625","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672207501A","type":"NDC"}],"standard_charges":[{"gross_charge":17.09,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NA CL N","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005634","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":13.76,"discounted_cash":5.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"CIPROFFLOX 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500005641","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904724361A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANDIDA SKIN TEST","drug_information":{"unit":"0.02","type":"ML"},"code_information":[{"code":"2500005644","type":"CDM"},{"code":"250","type":"RC"},{"code":"59584013801","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOX/K CLAV 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500005648","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781187431","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL SR 180MG T","drug_information":{"unit":"180","type":"ME"},"code_information":[{"code":"2500005649","type":"CDM"},{"code":"259","type":"RC"},{"code":"75834015801A","type":"NDC"}],"standard_charges":[{"gross_charge":16.99,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL 2MG/5ML","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500005650","type":"CDM"},{"code":"259","type":"RC"},{"code":"70752010212A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORT 1% CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005658","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536140795A","type":"NDC"}],"standard_charges":[{"gross_charge":22.3,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"VASOPRESSIN I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500005662","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023016425A","type":"NDC"}],"standard_charges":[{"gross_charge":880.05,"discounted_cash":352.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUINIDINE GLUC 324MG T","drug_information":{"unit":"324","type":"ME"},"code_information":[{"code":"2500005668","type":"CDM"},{"code":"259","type":"RC"},{"code":"53489014101A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZ 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500005684","type":"CDM"},{"code":"259","type":"RC"},{"code":"59746011306A","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500005692","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409177805A","type":"NDC"}],"standard_charges":[{"gross_charge":29.28,"discounted_cash":11.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCITONIN 200IU I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005715","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"42023020501A","type":"NDC"}],"standard_charges":[{"gross_charge":6740.17,"discounted_cash":2696.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BRO INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005716","type":"CDM"},{"code":"250","type":"RC"},{"code":"00597008717","type":"NDC"}],"standard_charges":[{"gross_charge":570.71,"discounted_cash":228.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"NA ACETATE 40MEQ I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500005738","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409729973","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE 30MG CAPS","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500005741","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378143077A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOZAPINE 25MG TAB","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500005744","type":"CDM"},{"code":"259","type":"RC"},{"code":"69809012605A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACLIDI","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005745","type":"CDM"},{"code":"259","type":"RC"},{"code":"70515000202A","type":"NDC"}],"standard_charges":[{"gross_charge":210.69,"discounted_cash":84.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"LEVOTHYROXINE 100 MCG VIAL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005746","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323064916A","type":"NDC"}],"standard_charges":[{"gross_charge":597.12,"discounted_cash":238.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"LEVOBUNOLOL OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005748","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050505","type":"NDC"}],"standard_charges":[{"gross_charge":108.82,"discounted_cash":43.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"BETHANECOL 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500005755","type":"CDM"},{"code":"259","type":"RC"},{"code":"00832051201A","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUANFACINE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500005760","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378116001","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CA CARBONATE CHEW T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500005765","type":"CDM"},{"code":"259","type":"RC"},{"code":"66553000401","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLURBIPROFEN OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005768","type":"CDM"},{"code":"259","type":"RC"},{"code":"69292072225A","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CALAMINE LOTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005779","type":"CDM"},{"code":"250","type":"RC"},{"code":"00904253321A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"SIMETHICONE DROPS","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"2500005791","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122054703A","type":"NDC"}],"standard_charges":[{"gross_charge":47.42,"discounted_cash":18.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 125MG C","drug_information":{"unit":"125","type":"ME"},"code_information":[{"code":"2500005795","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180016613A","type":"NDC"}],"standard_charges":[{"gross_charge":138.12,"discounted_cash":55.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CODEINE 30MG TAB","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500005803","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054024425A","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Sugammadex 200 mg/2 ml vial","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005847","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006542312A","type":"NDC"}],"standard_charges":[{"gross_charge":613.23,"discounted_cash":245.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSCYAMINE 0.125MG T","drug_information":{"unit":"0.125","type":"ME"},"code_information":[{"code":"2500005876","type":"CDM"},{"code":"259","type":"RC"},{"code":"42192034001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE 1MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005891","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"00143972905","type":"NDC"}],"standard_charges":[{"gross_charge":355.97,"discounted_cash":142.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM & SODIUM PHOSPATES E","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500005899","type":"CDM"},{"code":"259","type":"RC"},{"code":"60258000601B","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"GOLYTELY 4 LITERS","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"2500005904","type":"CDM"},{"code":"259","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":109.17,"discounted_cash":43.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Methylene Blue 20mg/2mL Syr","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005905","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288015905A","type":"NDC"}],"standard_charges":[{"gross_charge":247.97,"discounted_cash":99.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500005916","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079081020","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500005917","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180051301A","type":"NDC"}],"standard_charges":[{"gross_charge":6.65,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PLASMA LYTE A PH 7.4 SOL 1000M","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500005919","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338022104A","type":"NDC"}],"standard_charges":[{"gross_charge":74.09,"discounted_cash":29.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDAPAMIDE 2.5MG","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500005925","type":"CDM"},{"code":"259","type":"RC"},{"code":"00228257111A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE PCA I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500005994","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329191201A","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 3ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500005997","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409212288","type":"NDC"}],"standard_charges":[{"gross_charge":125.02,"discounted_cash":50.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FORT GENT OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500006003","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020A","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":24.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"FORT GENT OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500006003","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020B","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":24.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"BUPIVICAINE SPINAL I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500006106","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409176110","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Diltiazem 100mg/100ml IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500006210","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567066210A","type":"NDC"}],"standard_charges":[{"gross_charge":189.13,"discounted_cash":75.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ketamine 500mg/5ml vial","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500006269","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143950910A","type":"NDC"}],"standard_charges":[{"gross_charge":65.82,"discounted_cash":26.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZO/TETRA TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500006314","type":"CDM"},{"code":"250","type":"RC"},{"code":"10223020104A","type":"NDC"}],"standard_charges":[{"gross_charge":343.62,"discounted_cash":137.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"DICLOFENAC NA 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500006441","type":"CDM"},{"code":"259","type":"RC"},{"code":"16571020310A","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 0.375 GM CAPSULE","drug_information":{"unit":"0.375","type":"GM"},"code_information":[{"code":"2500006452","type":"CDM"},{"code":"259","type":"RC"},{"code":"65649010302A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN 25GM I","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500006453","type":"CDM"},{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"64208251207A","type":"NDC"}],"standard_charges":[{"gross_charge":898.75,"discounted_cash":359.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTERNAGEL 12OZ L","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500006456","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536009185A","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":6.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOLAZONE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500006470","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079002420A","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIM 1.5 GM I","drug_information":{"unit":"1.5","type":"GM"},"code_information":[{"code":"2500006476","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143997722","type":"NDC"}],"standard_charges":[{"gross_charge":73.28,"discounted_cash":29.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME 1.5GM IVPB","drug_information":{"unit":"1500","type":"ME"},"code_information":[{"code":"2500006477","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143997722A","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVASTATIN 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500006481","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084055901A","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOCOCCAL VACCINE","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500006492","type":"CDM"},{"code":"636","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"00006483703A","type":"NDC"}],"standard_charges":[{"gross_charge":348.14,"discounted_cash":139.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXIN 200MG I","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500006495","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323064710A","type":"NDC"}],"standard_charges":[{"gross_charge":1053.06,"discounted_cash":421.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"FLUOXETINE 20MG C","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500006501","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904734661A","type":"NDC"}],"standard_charges":[{"gross_charge":23.57,"discounted_cash":9.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE PF 5MG/10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500006532","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"00409381412","type":"NDC"}],"standard_charges":[{"gross_charge":35.89,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPTAVAX B 1ML I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500006535","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006498100A","type":"NDC"}],"standard_charges":[{"gross_charge":272.04,"discounted_cash":108.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE L","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500006544","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094012962A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANCRELIPASE C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500006555","type":"CDM"},{"code":"259","type":"RC"},{"code":"73562011501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"TERAZOSIN 1MG C","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500006556","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079093620","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED 80MG SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500006558","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157405A","type":"NDC"}],"standard_charges":[{"gross_charge":81.45,"discounted_cash":32.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Naloxone 4mg spray","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500006568","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802057884A","type":"NDC"}],"standard_charges":[{"gross_charge":322.08,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDRINE SULFATE 50MG/10ML VL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500006601","type":"CDM"},{"code":"250","type":"RC"},{"code":"14789025010A","type":"NDC"}],"standard_charges":[{"gross_charge":132.9,"discounted_cash":53.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CARB 30MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500006896","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054252725A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500006909","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0281","type":"HCPCS"},{"code":"00517912025A","type":"NDC"}],"standard_charges":[{"gross_charge":74.09,"discounted_cash":29.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500006911","type":"CDM"},{"code":"259","type":"RC"},{"code":"16714040102A","type":"NDC"}],"standard_charges":[{"gross_charge":48.63,"discounted_cash":19.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISOPROSTOL 100MCG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500006917","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687073501B","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"LACTULOSE L","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500006926","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121115400A","type":"NDC"}],"standard_charges":[{"gross_charge":14.77,"discounted_cash":5.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORBITOL 70% 30ML L","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500006928","type":"CDM"},{"code":"259","type":"RC"},{"code":"46287050030A","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 20MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500006932","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPRO ACID 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500006980","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904686061A","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAPAVERINE 2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500007018","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"00517400225","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOX/CLAV 200/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500007031","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781610252","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFADROXIL 250/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500007033","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180018102","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIMETHOBENZAMIDE I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500007040","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"42023011925A","type":"NDC"}],"standard_charges":[{"gross_charge":241.25,"discounted_cash":96.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPRO 100MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500007073","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094049461","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 100MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500007082","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"36000028425A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARISOPRODOL 350MG T","drug_information":{"unit":"350","type":"ME"},"code_information":[{"code":"2500007085","type":"CDM"},{"code":"259","type":"RC"},{"code":"50228010910A","type":"NDC"}],"standard_charges":[{"gross_charge":24.54,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 1 GM IVPB","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500007090","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040120A","type":"NDC"}],"standard_charges":[{"gross_charge":144.7,"discounted_cash":57.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORMAL SALINE 0.9% 100ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500007110","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990798423A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE XL 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500007117","type":"CDM"},{"code":"259","type":"RC"},{"code":"62175026055A","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 30MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500007129","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMP/SULBAC 3GM IVPB","drug_information":{"unit":"3000","type":"ME"},"code_information":[{"code":"2500007133","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641611710A","type":"NDC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 6MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500007183","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021031802A","type":"NDC"}],"standard_charges":[{"gross_charge":34.3,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPO 3 000 U I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500007212","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030301A","type":"NDC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPO 4 000 U I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500007213","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030401A","type":"NDC"}],"standard_charges":[{"gross_charge":564.33,"discounted_cash":225.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM 300MCG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500007216","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513053010A","type":"NDC"}],"standard_charges":[{"gross_charge":742.04,"discounted_cash":296.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM 480MCG I","drug_information":{"unit":"1.6","type":"ML"},"code_information":[{"code":"2500007217","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513054610","type":"NDC"}],"standard_charges":[{"gross_charge":2500.18,"discounted_cash":1000.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOX 400MG IVPB","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2500007218","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021011487A","type":"NDC"}],"standard_charges":[{"gross_charge":284.87,"discounted_cash":113.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 250MG I","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500007265","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733701A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 10MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500007277","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"80830118807A","type":"NDC"}],"standard_charges":[{"gross_charge":33.27,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOX 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500007280","type":"CDM"},{"code":"259","type":"RC"},{"code":"50419075801A","type":"NDC"}],"standard_charges":[{"gross_charge":26.1,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE XL 60MG T","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500007283","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268059815A","type":"NDC"}],"standard_charges":[{"gross_charge":10.64,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM 5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500007316","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641601310Z","type":"NDC"}],"standard_charges":[{"gross_charge":100.78,"discounted_cash":40.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 250MCG PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500007317","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378912198A","type":"NDC"}],"standard_charges":[{"gross_charge":88.04,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"}]},{"description":"FENTANYL 50MCG PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500007318","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378912298A","type":"NDC"}],"standard_charges":[{"gross_charge":160.94,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 75MCG PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500007319","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378912398A","type":"NDC"}],"standard_charges":[{"gross_charge":245.47,"discounted_cash":98.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"FLUMAZENIL 5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500007329","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000014810A","type":"NDC"}],"standard_charges":[{"gross_charge":38.63,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE PATCH 21MG","drug_information":{"unit":"21","type":"ME"},"code_information":[{"code":"2500007337","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536589688","type":"NDC"}],"standard_charges":[{"gross_charge":16.71,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM CD 120MG C","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2500007360","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505001406A","type":"NDC"}],"standard_charges":[{"gross_charge":8.45,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KI 10% FOR OT","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"2500007377","type":"CDM"},{"code":"250","type":"RC"},{"code":"71740011208A","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJ EST I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500007380","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1410","type":"HCPCS"},{"code":"00046074905","type":"NDC"}],"standard_charges":[{"gross_charge":744.73,"discounted_cash":297.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLESEVELAM 3.75 GM PACKET","drug_information":{"unit":"3.75","type":"GM"},"code_information":[{"code":"2500007450","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877052330A","type":"NDC"}],"standard_charges":[{"gross_charge":141.2,"discounted_cash":56.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOCARNITINE 200MG/ML","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500007451","type":"CDM"},{"code":"250","type":"RC"},{"code":"54482014701A","type":"NDC"}],"standard_charges":[{"gross_charge":72.93,"discounted_cash":29.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 80MG/15ML","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500007855","type":"CDM"},{"code":"259","type":"RC"},{"code":"27808003301A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 100MC PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500007995","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378912498A","type":"NDC"}],"standard_charges":[{"gross_charge":325.77,"discounted_cash":130.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"FLUCONAZOLE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500007996","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268033715A","type":"NDC"}],"standard_charges":[{"gross_charge":59.77,"discounted_cash":23.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500007997","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762306003A","type":"NDC"}],"standard_charges":[{"gross_charge":47.94,"discounted_cash":19.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 200MG C","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500007998","type":"CDM"},{"code":"259","type":"RC"},{"code":"72578000201A","type":"NDC"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 0.3% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008000","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314064305","type":"NDC"}],"standard_charges":[{"gross_charge":256.29,"discounted_cash":102.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CLARITHROMY 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500008001","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687043521A","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMIPRIL 2.5MG C","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500008002","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862047501A","type":"NDC"}],"standard_charges":[{"gross_charge":8.14,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN 6MG I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500008024","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"00173044902","type":"NDC"}],"standard_charges":[{"gross_charge":978.2,"discounted_cash":391.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 4% TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008038","type":"CDM"},{"code":"250","type":"RC"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":47.08,"discounted_cash":18.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CLINDAMYCIN V","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008053","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168027740","type":"NDC"}],"standard_charges":[{"gross_charge":618.53,"discounted_cash":247.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"KETOROLAC 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500008057","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378113401","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500008061","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877019810A","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500008074","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084004501A","type":"NDC"}],"standard_charges":[{"gross_charge":15.07,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE SODIUM 180MG TAB","drug_information":{"unit":"180","type":"ME"},"code_information":[{"code":"2500008084","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078038566","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 10MG TABS","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500008085","type":"CDM"},{"code":"259","type":"RC"},{"code":"10702005601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FORMOTEROL 20 MCG INHALATION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008086","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502060561A","type":"NDC"}],"standard_charges":[{"gross_charge":71.91,"discounted_cash":28.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"ZOLIPIDEM 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500008122","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687083801A","type":"NDC"}],"standard_charges":[{"gross_charge":21.48,"discounted_cash":8.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500008123","type":"CDM"},{"code":"259","type":"RC"},{"code":"00555088702","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 30MG I","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"2500008130","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548560100A","type":"NDC"}],"standard_charges":[{"gross_charge":33.99,"discounted_cash":13.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON 2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500008138","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005A","type":"NDC"}],"standard_charges":[{"gross_charge":29.26,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXAZEPAM 15MG C","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500008195","type":"CDM"},{"code":"259","type":"RC"},{"code":"62584081301","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SERTRALINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500008196","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687024201A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETODOLAC 200MG C","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500008197","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505003901","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN UP TO 80 MG UNITS","drug_information":{"unit":"1.2","type":"GM"},"code_information":[{"code":"2500008206","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"39822041201","type":"NDC"}],"standard_charges":[{"gross_charge":992.08,"discounted_cash":396.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN 0.5GM T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500008208","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093117701A","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 50ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500008221","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409909461C","type":"NDC"}],"standard_charges":[{"gross_charge":234.23,"discounted_cash":93.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROCURONIUM BROMIDE I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500008222","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781322092A","type":"NDC"}],"standard_charges":[{"gross_charge":44.59,"discounted_cash":17.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BRO UD PER MG UNIT","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"2500008230","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"00487980160","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTORPHANOL N","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008238","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505081301","type":"NDC"}],"standard_charges":[{"gross_charge":404.01,"discounted_cash":161.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"RISPERIDONE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500008242","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458030001","type":"NDC"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500008243","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458032001","type":"NDC"}],"standard_charges":[{"gross_charge":46.52,"discounted_cash":18.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE 37.5MG T","drug_information":{"unit":"37.5","type":"ME"},"code_information":[{"code":"2500008244","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079048020A","type":"NDC"}],"standard_charges":[{"gross_charge":9.49,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLAT 1% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008256","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":76.56,"discounted_cash":30.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"NITRO SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008257","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802021001A","type":"NDC"}],"standard_charges":[{"gross_charge":498.94,"discounted_cash":199.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"LUPRON INJ 7.5MG","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2500008282","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074364203","type":"NDC"}],"standard_charges":[{"gross_charge":1549.0,"discounted_cash":619.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION 75MG T","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500008344","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079094320","type":"NDC"}],"standard_charges":[{"gross_charge":9.53,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE MIC 3MG T","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2500008345","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093803501A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE INHO PER MG UNIT","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500008348","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323066501B","type":"NDC"}],"standard_charges":[{"gross_charge":154.2,"discounted_cash":61.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL UD","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500008355","type":"CDM"},{"code":"250","type":"RC"},{"code":"00487950160","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Omegaven 10% 10g/100ml btl","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500008357","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323020500A","type":"NDC"}],"standard_charges":[{"gross_charge":377.76,"discounted_cash":151.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM 10ML INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500008359","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641601410E","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MGW ENEMA","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008361","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677121001B","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":24.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAKINS SOLUTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008370","type":"CDM"},{"code":"250","type":"RC"},{"code":"00436093616","type":"NDC"}],"standard_charges":[{"gross_charge":37.17,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"POLY/BAC TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008407","type":"CDM"},{"code":"250","type":"RC"},{"code":"58980001205A","type":"NDC"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":12.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TAPENTADOL ER 50 MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500008452","type":"CDM"},{"code":"259","type":"RC"},{"code":"24510005860A","type":"NDC"}],"standard_charges":[{"gross_charge":39.02,"discounted_cash":15.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-QUINIDINE CAP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008456","type":"CDM"},{"code":"259","type":"RC"},{"code":"59148005316A","type":"NDC"}],"standard_charges":[{"gross_charge":52.09,"discounted_cash":20.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"SODIUM THIOSULFATE 12.5 GRAM V","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500008487","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267070550A","type":"NDC"}],"standard_charges":[{"gross_charge":461.34,"discounted_cash":184.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASENAPINE MALEATE 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500008500","type":"CDM"},{"code":"259","type":"RC"},{"code":"62332019860A","type":"NDC"}],"standard_charges":[{"gross_charge":66.5,"discounted_cash":26.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRABE 25MG","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500008501","type":"CDM"},{"code":"259","type":"RC"},{"code":"00469260130A","type":"NDC"}],"standard_charges":[{"gross_charge":43.14,"discounted_cash":17.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN/DEX OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008545","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078087601","type":"NDC"}],"standard_charges":[{"gross_charge":1051.9,"discounted_cash":420.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CLONAZEPAM 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2500008546","type":"CDM"},{"code":"259","type":"RC"},{"code":"16729013600A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IV HEPARIN MIX","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500008548","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409315020","type":"NDC"}],"standard_charges":[{"gross_charge":58.52,"discounted_cash":23.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE ISOD BENZ I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500008549","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517250210","type":"NDC"}],"standard_charges":[{"gross_charge":70.61,"discounted_cash":28.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN/DEX OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008570","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314064725A","type":"NDC"}],"standard_charges":[{"gross_charge":206.06,"discounted_cash":82.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"NEFAZODONE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500008571","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093102406","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOSARTAN K 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500008572","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084034701A","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPYRIDAMOLE 20ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500008577","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1245","type":"HCPCS"},{"code":"00641256944","type":"NDC"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500008578","type":"CDM"},{"code":"259","type":"RC"},{"code":"31722053001","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INJ BUPIVACAINE/EPINEPH 0.25%","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500008600","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046817A","type":"NDC"}],"standard_charges":[{"gross_charge":51.73,"discounted_cash":20.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INJ BUPIVA/EPI 0.5% 10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500008601","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046217A","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":13.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN 200MG I","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500008712","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081530A","type":"NDC"}],"standard_charges":[{"gross_charge":227.82,"discounted_cash":91.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE 2% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008713","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208048510A","type":"NDC"}],"standard_charges":[{"gross_charge":320.28,"discounted_cash":128.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CIPROFLOXACIN OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008715","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"gross_charge":600.59,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"MOMETASONE FUR TOP","drug_information":{"unit":"15","type":"GM"},"code_information":[{"code":"2500008731","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713063415A","type":"NDC"}],"standard_charges":[{"gross_charge":109.98,"discounted_cash":43.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERCONAZOLE 7 V","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008732","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672130406A","type":"NDC"}],"standard_charges":[{"gross_charge":154.35,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TERCONAZOLE 3 V","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008733","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802071708A","type":"NDC"}],"standard_charges":[{"gross_charge":184.07,"discounted_cash":73.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPP"}]},{"description":"TRAMADOL 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500008734","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079099120","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROFUR MAC 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500008735","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904713761A","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORHEXIDINE GLUC L","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500008739","type":"CDM"},{"code":"259","type":"RC"},{"code":"00116200116","type":"NDC"}],"standard_charges":[{"gross_charge":74.33,"discounted_cash":29.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE ER 15 MG TAB","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500008770","type":"CDM"},{"code":"259","type":"RC"},{"code":"59011041520A","type":"NDC"}],"standard_charges":[{"gross_charge":19.22,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE/VILANTEROL INHALER","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008807","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173085914A","type":"NDC"}],"standard_charges":[{"gross_charge":453.79,"discounted_cash":181.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"VENLAFAXINE 50 MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500008808","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001015900A","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D51/2NS 10KCL 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500008955","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338066904A","type":"NDC"}],"standard_charges":[{"gross_charge":47.4,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NS S20K 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500008956","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990711509","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D51/2S40K 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500008957","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990790409A","type":"NDC"}],"standard_charges":[{"gross_charge":98.86,"discounted_cash":39.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UMECLIDINIUM/VILANTEROL IH IP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500008991","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173086906A","type":"NDC"}],"standard_charges":[{"gross_charge":349.61,"discounted_cash":139.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"SAXAGLIPTIN 2.5 MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500008999","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862082530A","type":"NDC"}],"standard_charges":[{"gross_charge":46.31,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1%/EPI 1:100K 10ML","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500009011","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048201A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hextend 30g/500ml bag","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500009082","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409155554A","type":"NDC"}],"standard_charges":[{"gross_charge":429.74,"discounted_cash":171.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 7.5 MG TAB","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2500009480","type":"CDM"},{"code":"259","type":"RC"},{"code":"57237000730A","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Dexmedetomidine 1000mcg/250ml","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500009564","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409143401A","type":"NDC"}],"standard_charges":[{"gross_charge":959.42,"discounted_cash":383.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Potassium Phos 22 MEQ/250ml NS","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500009565","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121172209A","type":"NDC"}],"standard_charges":[{"gross_charge":267.99,"discounted_cash":107.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACUBITRIL/VALSARTAN 49MG/51 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500009800","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078077720A","type":"NDC"}],"standard_charges":[{"gross_charge":35.6,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"SACUBITRIL/VALSARTAN 97MG/103","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500009801","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078069620A","type":"NDC"}],"standard_charges":[{"gross_charge":35.6,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"Oxytocin 30u/500mL NS bag","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500009803","type":"CDM"},{"code":"250","type":"RC"},{"code":"70092106807A","type":"NDC"}],"standard_charges":[{"gross_charge":113.01,"discounted_cash":45.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJ ESTR V","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500009858","type":"CDM"},{"code":"250","type":"RC"},{"code":"00046087221A","type":"NDC"}],"standard_charges":[{"gross_charge":1956.13,"discounted_cash":782.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"FOSINOPRIL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500009921","type":"CDM"},{"code":"259","type":"RC"},{"code":"43547038609A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN POWDER TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500009925","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":130.34,"discounted_cash":52.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"DINOPROSTONE 10MG V","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500009940","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566280001","type":"NDC"}],"standard_charges":[{"gross_charge":731.62,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLLAGENASE OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500009942","type":"CDM"},{"code":"259","type":"RC"},{"code":"50484001030A","type":"NDC"}],"standard_charges":[{"gross_charge":1125.83,"discounted_cash":450.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"OCTREOTIDE 50MCG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500009943","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323036501A","type":"NDC"}],"standard_charges":[{"gross_charge":58.89,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE RECOMBINANT 100MG I","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500009950","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242008527","type":"NDC"}],"standard_charges":[{"gross_charge":43887.82,"discounted_cash":17555.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPY 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500009951","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884006601A","type":"NDC"}],"standard_charges":[{"gross_charge":19.17,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPO 10 000 U I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500009952","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676031001A","type":"NDC"}],"standard_charges":[{"gross_charge":1393.97,"discounted_cash":557.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED SODIUM SUCC 500","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500009953","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009075801","type":"NDC"}],"standard_charges":[{"gross_charge":81.41,"discounted_cash":32.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 1.5MG/15ML","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500010103","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409148302A","type":"NDC"}],"standard_charges":[{"gross_charge":50.94,"discounted_cash":20.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 300 MG L","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500010555","type":"CDM"},{"code":"259","type":"RC"},{"code":"00009076004","type":"NDC"}],"standard_charges":[{"gross_charge":40.79,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANSOPRAZOLE 30MG C","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500010733","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764054411","type":"NDC"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METFORMIN 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500010735","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687015501B","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAZOSIN MES4 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500010756","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079095820","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENAZEPRIL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500010757","type":"CDM"},{"code":"259","type":"RC"},{"code":"43547033610A","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500010758","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084037101A","type":"NDC"}],"standard_charges":[{"gross_charge":20.79,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 1GM IVPB","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500010762","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525A","type":"NDC"}],"standard_charges":[{"gross_charge":91.51,"discounted_cash":36.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALENDRONATE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500010763","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980034003A","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIACALCIN NASAL SPR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500010765","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082306A","type":"NDC"}],"standard_charges":[{"gross_charge":568.85,"discounted_cash":227.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"CARBOPROST/TROMET I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500010835","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009085608","type":"NDC"}],"standard_charges":[{"gross_charge":1481.74,"discounted_cash":592.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOTIFEN FUMARATE OPHTH 5ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011013","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385010617A","type":"NDC"}],"standard_charges":[{"gross_charge":57.86,"discounted_cash":23.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"XYLO 1% 50ML LIPO I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500011141","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409427602","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAG OX 140MG C","drug_information":{"unit":"140","type":"ME"},"code_information":[{"code":"2500011143","type":"CDM"},{"code":"259","type":"RC"},{"code":"60569049501A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROP/ALBUT INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011148","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597002402A","type":"NDC"}],"standard_charges":[{"gross_charge":1772.28,"discounted_cash":708.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"IPRATROP/ALBUT UD","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500011149","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378967193Z","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMM GLOB 10GM IV","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500011153","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085003A","type":"NDC"}],"standard_charges":[{"gross_charge":8556.19,"discounted_cash":3422.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE 2MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500011156","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150019520A","type":"NDC"}],"standard_charges":[{"gross_charge":47.84,"discounted_cash":19.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE 2MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500011156","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323028513A","type":"NDC"}],"standard_charges":[{"gross_charge":47.84,"discounted_cash":19.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE 5MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500011157","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323028620","type":"NDC"}],"standard_charges":[{"gross_charge":58.04,"discounted_cash":23.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR IRR 500ML","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500011178","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264210110A","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR IRR 2000ML","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500011188","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990797307A","type":"NDC"}],"standard_charges":[{"gross_charge":97.24,"discounted_cash":38.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN UP TO 80 MG UNITS","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500011212","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050548A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIAXIN 250/5ML","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011232","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781602352A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOC 2%EPI 1:1000,00030ML V","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500011234","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409318202A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIBUCAINE TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011600","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536121195A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"SEBULEX SHAMPOO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011601","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536196297","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"SELENIUM SULFIDE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011602","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536199553A","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MAFENIDE TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011604","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571072360A","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TOLNAFTATE TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011605","type":"CDM"},{"code":"259","type":"RC"},{"code":"11017041005A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"VICKS VAPO RUB TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011606","type":"CDM"},{"code":"259","type":"RC"},{"code":"23900000361A","type":"NDC"}],"standard_charges":[{"gross_charge":17.38,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CAPSAICIN TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011607","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536252525","type":"NDC"}],"standard_charges":[{"gross_charge":47.23,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"D70W 1000ML","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500011608","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264738750A","type":"NDC"}],"standard_charges":[{"gross_charge":203.24,"discounted_cash":81.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 1GM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500011609","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"gross_charge":187.67,"discounted_cash":75.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 2GM I","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500011610","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"gross_charge":381.31,"discounted_cash":152.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTINEX PKTS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011613","type":"CDM"},{"code":"259","type":"RC"},{"code":"71351001312A","type":"NDC"}],"standard_charges":[{"gross_charge":4.45,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"ASA 300MG R","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500011620","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574703412","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHOTERICIN B I","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011621","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0285","type":"HCPCS"},{"code":"39822105505A","type":"NDC"}],"standard_charges":[{"gross_charge":91.46,"discounted_cash":36.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HBIG 5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011622","type":"CDM"},{"code":"636","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"69800420301","type":"NDC"}],"standard_charges":[{"gross_charge":2383.55,"discounted_cash":953.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAFCILLIN 2GM I","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500011623","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2290","type":"HCPCS"},{"code":"63323032820A","type":"NDC"}],"standard_charges":[{"gross_charge":164.55,"discounted_cash":65.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011624","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"00006351659","type":"NDC"}],"standard_charges":[{"gross_charge":151.65,"discounted_cash":60.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMP/SULBAC 1.5 I","drug_information":{"unit":"1.5","type":"GM"},"code_information":[{"code":"2500011625","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021014220A","type":"NDC"}],"standard_charges":[{"gross_charge":31.32,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMP/SULBAC 3GM I","drug_information":{"unit":"3","type":"GM"},"code_information":[{"code":"2500011626","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034910A","type":"NDC"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":13.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ST H20 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500011627","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990799009A","type":"NDC"}],"standard_charges":[{"gross_charge":55.35,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 60MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500011633","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379601A","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 500MG I","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011634","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"67457061220D","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"VANCOMYCIN 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011634","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"70436002082A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1GM I","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500011635","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323028420A","type":"NDC"}],"standard_charges":[{"gross_charge":90.56,"discounted_cash":36.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE 100MG I","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500011636","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"66794023741A","type":"NDC"}],"standard_charges":[{"gross_charge":89.23,"discounted_cash":35.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500011638","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069010125A","type":"NDC"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011639","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409733801A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA CL CONC 23.4% I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500011640","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323009330A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEN G POT 20MU I","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011641","type":"CDM"},{"code":"250","type":"RC"},{"code":"00049053028","type":"NDC"}],"standard_charges":[{"gross_charge":121.12,"discounted_cash":48.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MMU"}]},{"description":"KCL 40MEQ I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500011646","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409665305","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"K ACETATE I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500011647","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409818301","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUORESCEIN I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500011649","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065009265","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL DEC I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500011650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"70069038101A","type":"NDC"}],"standard_charges":[{"gross_charge":135.56,"discounted_cash":54.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFEROXAMINE MES I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011653","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"00078046791","type":"NDC"}],"standard_charges":[{"gross_charge":46.31,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CA CL 10% I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500011656","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517671010Z","type":"NDC"}],"standard_charges":[{"gross_charge":48.59,"discounted_cash":19.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOTAXIME 1GM I","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500011659","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409359511A","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 900MG I","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"2500011661","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009090218A","type":"NDC"}],"standard_charges":[{"gross_charge":166.97,"discounted_cash":66.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COSYNTROPIN I","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2500011662","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"00548590000","type":"NDC"}],"standard_charges":[{"gross_charge":607.05,"discounted_cash":242.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETH 4MG 30ML I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500011663","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457042130Z","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 30ML I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500011665","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023016801A","type":"NDC"}],"standard_charges":[{"gross_charge":1215.33,"discounted_cash":486.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 1GM I","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500011666","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781940495A","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":16.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 1GM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500011666","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781940495","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":16.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 2GM I","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500011667","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781940895","type":"NDC"}],"standard_charges":[{"gross_charge":79.51,"discounted_cash":31.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASCORBIC ACID I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500011668","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457011850A","type":"NDC"}],"standard_charges":[{"gross_charge":82.49,"discounted_cash":33.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 500MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500011671","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219062210","type":"NDC"}],"standard_charges":[{"gross_charge":85.43,"discounted_cash":34.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAXOLOL 0.25% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011673","type":"CDM"},{"code":"250","type":"RC"},{"code":"00078072910","type":"NDC"}],"standard_charges":[{"gross_charge":770.03,"discounted_cash":308.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"FLUOROMETHOLONE OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011676","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"gross_charge":133.89,"discounted_cash":53.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"BAC/NEO/POLY OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011677","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208078055","type":"NDC"}],"standard_charges":[{"gross_charge":185.24,"discounted_cash":74.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TIMOLOL XE 0.25% GEL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011680","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022405","type":"NDC"}],"standard_charges":[{"gross_charge":182.91,"discounted_cash":73.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"TIMOLOL XE 0.5% GEL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011681","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022505","type":"NDC"}],"standard_charges":[{"gross_charge":277.65,"discounted_cash":111.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"FLUTICASONE 220 INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011688","type":"CDM"},{"code":"259","type":"RC"},{"code":"66993008096A","type":"NDC"}],"standard_charges":[{"gross_charge":731.62,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"FLUTICASONE INHN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011689","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054327099A","type":"NDC"}],"standard_charges":[{"gross_charge":357.25,"discounted_cash":142.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"FLUTICASONE 110 INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011690","type":"CDM"},{"code":"259","type":"RC"},{"code":"66993007996A","type":"NDC"}],"standard_charges":[{"gross_charge":782.09,"discounted_cash":312.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"AMANTADIN 50MG/5ML L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500011696","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121064610","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL 2MG/ML L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500011698","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121058104A","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACT CHAR SORB 50GM L","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"2500011700","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574052076A","type":"NDC"}],"standard_charges":[{"gross_charge":100.15,"discounted_cash":40.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACT CHAR AQUE 50GM L","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"2500011702","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574052176A","type":"NDC"}],"standard_charges":[{"gross_charge":100.15,"discounted_cash":40.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOX/CLAV 400/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011705","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781610452","type":"NDC"}],"standard_charges":[{"gross_charge":27.34,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOX/CLAV 250/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011706","type":"CDM"},{"code":"259","type":"RC"},{"code":"81964020407A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMIN 4OZ L","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"2500011708","type":"CDM"},{"code":"259","type":"RC"},{"code":"24385037926A","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROI ACID 250/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011709","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121467500A","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFADROXIL 500/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011711","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180018202","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011713","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802035803A","type":"NDC"}],"standard_charges":[{"gross_charge":18.94,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"BEN GAY TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011714","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536134957A","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"PERMETHRIN TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011718","type":"CDM"},{"code":"259","type":"RC"},{"code":"00472024260","type":"NDC"}],"standard_charges":[{"gross_charge":196.63,"discounted_cash":78.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"EUCERIN TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011719","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904775127A","type":"NDC"}],"standard_charges":[{"gross_charge":62.08,"discounted_cash":24.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NOREPINEPHRINE 4MG/250ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500011720","type":"CDM"},{"code":"250","type":"RC"},{"code":"52533013418","type":"NDC"}],"standard_charges":[{"gross_charge":118.66,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORT 1% OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011724","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168002031","type":"NDC"}],"standard_charges":[{"gross_charge":19.13,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LACHYDRIN LOTION 12%","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011727","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802052555","type":"NDC"}],"standard_charges":[{"gross_charge":86.57,"discounted_cash":34.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TERBINAFINE TOP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011728","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672208001A","type":"NDC"}],"standard_charges":[{"gross_charge":121.55,"discounted_cash":48.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MICONAZOLE 3 V","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011732","type":"CDM"},{"code":"259","type":"RC"},{"code":"00472173803","type":"NDC"}],"standard_charges":[{"gross_charge":354.76,"discounted_cash":141.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPP"}]},{"description":"ACETAMIN 120MG R","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2500011734","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802073233A","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMIN 325MG R","drug_information":{"unit":"325","type":"ME"},"code_information":[{"code":"2500011735","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672211602Z","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREP H CREAM R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011737","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536128806A","type":"NDC"}],"standard_charges":[{"gross_charge":44.14,"discounted_cash":17.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"PROCTOFOAM HC","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011738","type":"CDM"},{"code":"259","type":"RC"},{"code":"00037682210","type":"NDC"}],"standard_charges":[{"gross_charge":200.27,"discounted_cash":80.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"PROMETHAZIN 12.5MG R","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2500011739","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713053612","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":8.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 50MG R","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011740","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713013212","type":"NDC"}],"standard_charges":[{"gross_charge":30.47,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"URSODIOL C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500011742","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591315901A","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTON 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011743","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079097920","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011744","type":"CDM"},{"code":"259","type":"RC"},{"code":"49411005030A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 50MG","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011745","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781214501","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MECLIZINE 12.5MG T","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2500011746","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268052215A","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500011747","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155083301A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASA 81MG CHEWABLE T","drug_information":{"unit":"81","type":"ME"},"code_information":[{"code":"2500011749","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904679480A","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASA 81MG E.C. T","drug_information":{"unit":"81","type":"ME"},"code_information":[{"code":"2500011750","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904675180A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500011751","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155050101A","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFASALAZIN 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011752","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762500005A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFEN ER 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500011753","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084057201A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011754","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527131101A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUSPIRONE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011755","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378115001a","type":"NDC"}],"standard_charges":[{"gross_charge":8.38,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CA CARB 500MG T","drug_information":{"unit":"648","type":"ME"},"code_information":[{"code":"2500011756","type":"CDM"},{"code":"259","type":"RC"},{"code":"20555000500A","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM CD 180MG C","drug_information":{"unit":"180","type":"ME"},"code_information":[{"code":"2500011759","type":"CDM"},{"code":"259","type":"RC"},{"code":"10370083011A","type":"NDC"}],"standard_charges":[{"gross_charge":9.99,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM CD 240MG C","drug_information":{"unit":"240","type":"ME"},"code_information":[{"code":"2500011760","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687021701A","type":"NDC"}],"standard_charges":[{"gross_charge":12.88,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM CD 300MG C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500011761","type":"CDM"},{"code":"259","type":"RC"},{"code":"47335067881A","type":"NDC"}],"standard_charges":[{"gross_charge":18.98,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011762","type":"CDM"},{"code":"259","type":"RC"},{"code":"72819015110A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE PATCH 2","drug_information":{"unit":"0.2","type":"ME"},"code_information":[{"code":"2500011763","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378087299A","type":"NDC"}],"standard_charges":[{"gross_charge":294.41,"discounted_cash":117.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.2MG T","drug_information":{"unit":"0.2","type":"ME"},"code_information":[{"code":"2500011764","type":"CDM"},{"code":"259","type":"RC"},{"code":"00228212810A","type":"NDC"}],"standard_charges":[{"gross_charge":8.63,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPHENIRAMI 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500011765","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904001261A","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 7.5MG T","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2500011769","type":"CDM"},{"code":"259","type":"RC"},{"code":"65162076810A","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULINDAC 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500011770","type":"CDM"},{"code":"259","type":"RC"},{"code":"42806001101A","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLCHICINE 0.6MG T","drug_information":{"unit":"0.6","type":"ME"},"code_information":[{"code":"2500011771","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764011907B","type":"NDC"}],"standard_charges":[{"gross_charge":27.87,"discounted_cash":11.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500011776","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093171201A","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500011777","type":"CDM"},{"code":"259","type":"RC"},{"code":"62584098401A","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 3MG T","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2500011778","type":"CDM"},{"code":"259","type":"RC"},{"code":"65162076410A","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500011779","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093171601A","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500011780","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054817525","type":"NDC"}],"standard_charges":[{"gross_charge":9.53,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEMECLOCYCLI","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500011781","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687069101A","type":"NDC"}],"standard_charges":[{"gross_charge":46.31,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500011782","type":"CDM"},{"code":"259","type":"RC"},{"code":"31722053101","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPRO ACID 125MG C","drug_information":{"unit":"125","type":"ME"},"code_information":[{"code":"2500011783","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084031301","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500011784","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093943301","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMID 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500011785","type":"CDM"},{"code":"259","type":"RC"},{"code":"70756072111A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500011786","type":"CDM"},{"code":"259","type":"RC"},{"code":"62559099212A","type":"NDC"}],"standard_charges":[{"gross_charge":85.58,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALSALATE 750MG T","drug_information":{"unit":"750","type":"ME"},"code_information":[{"code":"2500011787","type":"CDM"},{"code":"259","type":"RC"},{"code":"42192036610A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOXACIL 250MG C","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500011788","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093312301","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISRADIPINE 2.5MG C","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500011789","type":"CDM"},{"code":"259","type":"RC"},{"code":"16252053901","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLLIN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011790","type":"CDM"},{"code":"259","type":"RC"},{"code":"16729017101A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500011791","type":"CDM"},{"code":"259","type":"RC"},{"code":"00555088602","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE EX C","drug_information":{"unit":"45","type":"ME"},"code_information":[{"code":"2500011793","type":"CDM"},{"code":"259","type":"RC"},{"code":"46017009660A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS GLUC 324MG T","drug_information":{"unit":"324","type":"ME"},"code_information":[{"code":"2500011794","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574050811","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYCARBOPHIL T","drug_information":{"unit":"625","type":"ME"},"code_information":[{"code":"2500011795","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904250091","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOL 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011796","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687055001A","type":"NDC"}],"standard_charges":[{"gross_charge":26.4,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE XL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011797","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980028001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011798","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079081120","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INTRALIPI 20% 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500011799","type":"CDM"},{"code":"250","type":"RC"},{"code":"65219053550A","type":"NDC"}],"standard_charges":[{"gross_charge":536.71,"discounted_cash":214.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE PATCH 14MG","drug_information":{"unit":"14","type":"ME"},"code_information":[{"code":"2500011800","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122035274A","type":"NDC"}],"standard_charges":[{"gross_charge":18.84,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE PATCH 7MG","drug_information":{"unit":"7","type":"ME"},"code_information":[{"code":"2500011801","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536110688A","type":"NDC"}],"standard_charges":[{"gross_charge":18.84,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500011802","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079073520A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011803","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079073620","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERAZOSIN 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011806","type":"CDM"},{"code":"259","type":"RC"},{"code":"59746038506A","type":"NDC"}],"standard_charges":[{"gross_charge":7.42,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISO MON ER 60MG T","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500011807","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904645061A","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZATHIOPRINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011808","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"68084022901","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRAN LA 60MG C","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500011809","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527411637A","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRAN LA 80MG C","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2500011810","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527411737A","type":"NDC"}],"standard_charges":[{"gross_charge":7.93,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISO MON 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500011811","type":"CDM"},{"code":"259","type":"RC"},{"code":"81665010310A","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BCP T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011817","type":"CDM"},{"code":"259","type":"RC"},{"code":"51862056406A","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LAMOTRIGINE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500011821","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173064460","type":"NDC"}],"standard_charges":[{"gross_charge":28.09,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUVASTATIN 20MG C","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500011823","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378802077A","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LHYO TR 0.375MG C","drug_information":{"unit":"0.375","type":"ME"},"code_information":[{"code":"2500011824","type":"CDM"},{"code":"259","type":"RC"},{"code":"51525011501A","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011825","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739047910A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETODOLAC 300MG C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500011826","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505004001","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMFIBROZOIL 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500011828","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687022401A","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM 400MG T","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500011830","type":"CDM"},{"code":"259","type":"RC"},{"code":"00603020922A","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPRED PACK 4MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011832","type":"CDM"},{"code":"259","type":"RC"},{"code":"59746000103","type":"NDC"}],"standard_charges":[{"gross_charge":164.41,"discounted_cash":65.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACK"}]},{"description":"THIORIDAZINE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500011833","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079056620","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011834","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079056720","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMIN 180MG T","drug_information":{"unit":"180","type":"ME"},"code_information":[{"code":"2500011836","type":"CDM"},{"code":"259","type":"RC"},{"code":"00187301330","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEXILETINE 150MG C","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500011838","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093873901","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL CR 10MEQ C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011840","type":"CDM"},{"code":"259","type":"RC"},{"code":"62037056001","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"PRAZOSIN 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011841","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079063220","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 800MG T","drug_information":{"unit":"800","type":"ME"},"code_information":[{"code":"2500011842","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877029601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE LOZ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011843","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574010777","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIMIDONE 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500011844","type":"CDM"},{"code":"259","type":"RC"},{"code":"53746054501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE 100MCG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500011845","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323037601A","type":"NDC"}],"standard_charges":[{"gross_charge":114.29,"discounted_cash":45.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOTHIXENE 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011846","type":"CDM"},{"code":"259","type":"RC"},{"code":"60219167501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOTHIXENE 2MG C","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500011847","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079058720","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHAZOLAMIDE 50MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500011848","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574079001","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIACIN 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011850","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904227260","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIEFEREX 150MG C","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500011852","type":"CDM"},{"code":"259","type":"RC"},{"code":"60258018501A","type":"NDC"}],"standard_charges":[{"gross_charge":6.08,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 6.5MG C","drug_information":{"unit":"6.5","type":"ME"},"code_information":[{"code":"2500011853","type":"CDM"},{"code":"259","type":"RC"},{"code":"49483022210A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 0.3MG PATCH","drug_information":{"unit":"0.3","type":"ME"},"code_information":[{"code":"2500011855","type":"CDM"},{"code":"259","type":"RC"},{"code":"50742051530A","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 0.4MG PATCH","drug_information":{"unit":"0.4","type":"ME"},"code_information":[{"code":"2500011856","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378911293","type":"NDC"}],"standard_charges":[{"gross_charge":15.33,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 0.6MG PATCH","drug_information":{"unit":"0.6","type":"ME"},"code_information":[{"code":"2500011857","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378911693A","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 0.8MG PATCH","drug_information":{"unit":"0.8","type":"ME"},"code_information":[{"code":"2500011858","type":"CDM"},{"code":"259","type":"RC"},{"code":"50742051830A","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORTRIPTYLINE 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011859","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406991003A","type":"NDC"}],"standard_charges":[{"gross_charge":17.18,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 250MG C","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500011860","type":"CDM"},{"code":"259","type":"RC"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHENAZINE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500011861","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904659961A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEPTO BISMOL T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011862","type":"CDM"},{"code":"259","type":"RC"},{"code":"37000047709A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"DIPYRIDAMOLE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011863","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980013401A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPYRIDAMOLE 75MG T","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500011864","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980013501A","type":"NDC"}],"standard_charges":[{"gross_charge":6.98,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE 125MG C","drug_information":{"unit":"125","type":"ME"},"code_information":[{"code":"2500011866","type":"CDM"},{"code":"259","type":"RC"},{"code":"52083026360","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CA ACETATE 667MG T","drug_information":{"unit":"667","type":"ME"},"code_information":[{"code":"2500011867","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781208102","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYCHLORQUINE 20MGT","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500011868","type":"CDM"},{"code":"259","type":"RC"},{"code":"63304029601A","type":"NDC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FELODIPINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011869","type":"CDM"},{"code":"259","type":"RC"},{"code":"13668013301A","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAVASTATIN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011870","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904589161A","type":"NDC"}],"standard_charges":[{"gross_charge":16.33,"discounted_cash":6.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PTU 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011872","type":"CDM"},{"code":"259","type":"RC"},{"code":"00480924201","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPRO 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011874","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762005601A","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011875","type":"CDM"},{"code":"259","type":"RC"},{"code":"50111064701","type":"NDC"}],"standard_charges":[{"gross_charge":23.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENAZOPY 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500011876","type":"CDM"},{"code":"259","type":"RC"},{"code":"42192080201A","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLESTYRAMINE PKT","drug_information":{"unit":"4","type":"GM"},"code_information":[{"code":"2500011877","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884046565A","type":"NDC"}],"standard_charges":[{"gross_charge":17.76,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA BICARB 10GM T","drug_information":{"unit":"650","type":"ME"},"code_information":[{"code":"2500011879","type":"CDM"},{"code":"259","type":"RC"},{"code":"66553000801","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSEUDOEPHED 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500011880","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904505359","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVIT W/ZINC T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011881","type":"CDM"},{"code":"259","type":"RC"},{"code":"80681011200A","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LTHYROXINE 0.088MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011882","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527134401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LTHYROXINE 0.05MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011883","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079044020","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"LTHYROXINE 0.2MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011884","type":"CDM"},{"code":"259","type":"RC"},{"code":"00074714811","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"FLECAINIDE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011885","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054001021","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPIN 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500011886","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687047901A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500011887","type":"CDM"},{"code":"259","type":"RC"},{"code":"24979024407A","type":"NDC"}],"standard_charges":[{"gross_charge":8.07,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZONATATE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500011888","type":"CDM"},{"code":"259","type":"RC"},{"code":"68382024701A","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMIN 650MG/20ML","drug_information":{"unit":"20.3","type":"ML"},"code_information":[{"code":"2500011890","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121197100A","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NABUMETONE 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011891","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591367005A","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMO 750MG T","drug_information":{"unit":"750","type":"ME"},"code_information":[{"code":"2500011892","type":"CDM"},{"code":"259","type":"RC"},{"code":"76385012401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500011893","type":"CDM"},{"code":"259","type":"RC"},{"code":"59651025601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACEBUTOLOL 200MG C","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500011894","type":"CDM"},{"code":"259","type":"RC"},{"code":"53746066901A","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEFAZODONE 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500011895","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093711306","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVO/CARB 25/250 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011896","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687083601A","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LEVO/CAR CR 50/200 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011897","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079092320","type":"NDC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"TETRACYCLINE 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011899","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155001801","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEO ER 200MG C","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500011900","type":"CDM"},{"code":"259","type":"RC"},{"code":"50474020001","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIMETHBENMID 250MG C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500011901","type":"CDM"},{"code":"259","type":"RC"},{"code":"53489037601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL ER 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500011902","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904632361A","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETHANECOL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011904","type":"CDM"},{"code":"259","type":"RC"},{"code":"00832051101A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500011906","type":"CDM"},{"code":"259","type":"RC"},{"code":"64679092302A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011907","type":"CDM"},{"code":"259","type":"RC"},{"code":"16714044401A","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL SR 240MG T","drug_information":{"unit":"240","type":"ME"},"code_information":[{"code":"2500011908","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462026001A","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBAL 500 MCG Tab","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011910","type":"CDM"},{"code":"259","type":"RC"},{"code":"77333093710A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"PYRIDOXINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500011911","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268085915A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASCORBIC ACID 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500011913","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904052361","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN D T","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2500011914","type":"CDM"},{"code":"259","type":"RC"},{"code":"43292055881","type":"NDC"}],"standard_charges":[{"gross_charge":7.07,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN E 400IU C","drug_information":{"unit":"400","type":"UN"},"code_information":[{"code":"2500011915","type":"CDM"},{"code":"259","type":"RC"},{"code":"77333095110A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION SR 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500011916","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591354160","type":"NDC"}],"standard_charges":[{"gross_charge":15.33,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011917","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904679861A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500011918","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904679961A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPRO/HCTZ 2.5MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011919","type":"CDM"},{"code":"259","type":"RC"},{"code":"29300018713A","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"ZINC T","drug_information":{"unit":"220","type":"ME"},"code_information":[{"code":"2500011920","type":"CDM"},{"code":"259","type":"RC"},{"code":"00731040106","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 200/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011922","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762314001","type":"NDC"}],"standard_charges":[{"gross_charge":54.41,"discounted_cash":21.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPIN 100/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500011923","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094030162","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN ADULT L","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500011926","type":"CDM"},{"code":"259","type":"RC"},{"code":"00005434462A","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMIFENTANIL 1MG I","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500011930","type":"CDM"},{"code":"250","type":"RC"},{"code":"72078003401","type":"NDC"}],"standard_charges":[{"gross_charge":319.07,"discounted_cash":127.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011931","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406575562","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE CR 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011932","type":"CDM"},{"code":"259","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"gross_charge":7.73,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE IR 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011934","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406055262","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDAT 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011935","type":"CDM"},{"code":"259","type":"RC"},{"code":"65580053101","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE 25MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500011936","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225C","type":"NDC"}],"standard_charges":[{"gross_charge":29.28,"discounted_cash":11.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 4MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500011939","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323085410A","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE CR 15MG T","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500011940","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406831562A","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":2.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE CR 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500011941","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406833062A","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2500011944","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079041720A","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTALBITAL/CAF/ACE T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500011946","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591264001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CLONAZEPAM 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500011948","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079088220","type":"NDC"}],"standard_charges":[{"gross_charge":7.01,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE 5 C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500011949","type":"CDM"},{"code":"259","type":"RC"},{"code":"00555015802A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL 30MG T","drug_information":{"unit":"32.4","type":"ME"},"code_information":[{"code":"2500011953","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904657561A","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARB 100MG T","drug_information":{"unit":"97.2","type":"ME"},"code_information":[{"code":"2500011955","type":"CDM"},{"code":"259","type":"RC"},{"code":"00603516821A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXAZEPAM 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011960","type":"CDM"},{"code":"259","type":"RC"},{"code":"62584081201","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500011962","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079028620","type":"NDC"}],"standard_charges":[{"gross_charge":18.8,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 10GM/2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500011963","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409230850","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 2MG/2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500011964","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860060002A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2500011965","type":"CDM"},{"code":"259","type":"RC"},{"code":"00228202910A","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500011966","type":"CDM"},{"code":"259","type":"RC"},{"code":"00228203110A","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE CR 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500011993","type":"CDM"},{"code":"259","type":"RC"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":14.81,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPIRAMATE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500012096","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458063965","type":"NDC"}],"standard_charges":[{"gross_charge":14.73,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOL SWAB EA","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012472","type":"CDM"},{"code":"250","type":"RC"},{"code":"00884629730A","type":"NDC"}],"standard_charges":[{"gross_charge":26.92,"discounted_cash":10.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SCOPOLAMINE PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012475","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019055304A","type":"NDC"}],"standard_charges":[{"gross_charge":91.42,"discounted_cash":36.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ACETIC ACID 5% SOLUTION","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500012477","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552005506A","type":"NDC"}],"standard_charges":[{"gross_charge":333.1,"discounted_cash":133.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE 500MG/10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012478","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150043910A","type":"NDC"}],"standard_charges":[{"gross_charge":73.8,"discounted_cash":29.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM PHOS 45MM/15ML VIAL","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500012479","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409729501A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE WATER 10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012480","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488710A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE 0.5% 15ML BTL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012481","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682092005A","type":"NDC"}],"standard_charges":[{"gross_charge":51.1,"discounted_cash":20.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"LIDOCAINE 1% 1:1000,000 50ML V","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500012482","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409317803A","type":"NDC"}],"standard_charges":[{"gross_charge":20.32,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1%EPI 1:2000000 30ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500012483","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048737A","type":"NDC"}],"standard_charges":[{"gross_charge":58.73,"discounted_cash":23.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPRINE 1000MCG/10ML SYR","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012485","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641614225A","type":"NDC"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISOPROSTOL 25MCG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012487","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687073501A","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"}]},{"description":"LACTULOSE BULK BOTTLE","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500012488","type":"CDM"},{"code":"250","type":"RC"},{"code":"00121115400B","type":"NDC"}],"standard_charges":[{"gross_charge":14.14,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE/EPI/TETRACAINE 3ML G","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012489","type":"CDM"},{"code":"250","type":"RC"},{"code":"62295823603A","type":"NDC"}],"standard_charges":[{"gross_charge":23.76,"discounted_cash":9.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE/EPI0.25% 50ML VIAL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500012490","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046157A","type":"NDC"}],"standard_charges":[{"gross_charge":70.34,"discounted_cash":28.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VAC PED 5MCG/0.5ML","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500012497","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082052A","type":"NDC"}],"standard_charges":[{"gross_charge":127.02,"discounted_cash":50.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE 1/12% 250ML EPIDUR","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500012500","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409116202C","type":"NDC"}],"standard_charges":[{"gross_charge":97.24,"discounted_cash":38.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSFOMYCIN 3GM PACKET","drug_information":{"unit":"3","type":"GM"},"code_information":[{"code":"2500012501","type":"CDM"},{"code":"259","type":"RC"},{"code":"69097057967A","type":"NDC"}],"standard_charges":[{"gross_charge":412.87,"discounted_cash":165.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CL 40MEQ/500ML NS","drug_information":{"unit":"520","type":"ML"},"code_information":[{"code":"2500012503","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338070348A","type":"NDC"}],"standard_charges":[{"gross_charge":30.85,"discounted_cash":12.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYAL/CHONDROITIN 1KIT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012508","type":"CDM"},{"code":"250","type":"RC"},{"code":"08065183135A","type":"NDC"}],"standard_charges":[{"gross_charge":787.5,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYAL/CHONDROITIN 1KIT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012508","type":"CDM"},{"code":"250","type":"RC"},{"code":"08065183150A","type":"NDC"}],"standard_charges":[{"gross_charge":787.5,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 250MG/50ML ENEMA","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500012509","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409015224D","type":"NDC"}],"standard_charges":[{"gross_charge":37.97,"discounted_cash":15.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE XR 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500012596","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729013212A","type":"NDC"}],"standard_charges":[{"gross_charge":46.78,"discounted_cash":18.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500012695","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084052501A","type":"NDC"}],"standard_charges":[{"gross_charge":44.95,"discounted_cash":17.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAFCILLIN 1GM I","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500012714","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2290","type":"HCPCS"},{"code":"44567022110A","type":"NDC"}],"standard_charges":[{"gross_charge":69.29,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOX/CLAV 125/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500012715","type":"CDM"},{"code":"259","type":"RC"},{"code":"43598001251","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 0.5% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012731","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023218105","type":"NDC"}],"standard_charges":[{"gross_charge":652.98,"discounted_cash":261.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CARBACHOL INTRAOCULAR","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"2500012740","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065002315","type":"NDC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA CAL 0.45% 250 ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500012743","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990798502","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500012744","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079013320","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APRACLONIDIN 0.5% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012745","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314066505A","type":"NDC"}],"standard_charges":[{"gross_charge":238.35,"discounted_cash":95.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"AMOX/CLAV 875MG T","drug_information":{"unit":"875","type":"ME"},"code_information":[{"code":"2500012746","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862050320A","type":"NDC"}],"standard_charges":[{"gross_charge":40.3,"discounted_cash":16.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500012747","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"00069315083A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012748","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574402235","type":"NDC"}],"standard_charges":[{"gross_charge":468.46,"discounted_cash":187.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"SMZ/TMP DS 10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012749","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2865","type":"HCPCS"},{"code":"70069036210A","type":"NDC"}],"standard_charges":[{"gross_charge":72.17,"discounted_cash":28.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOCAINE CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012751","type":"CDM"},{"code":"259","type":"RC"},{"code":"63736003751A","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"BRIMONIDINE 0.2% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012753","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023917705","type":"NDC"}],"standard_charges":[{"gross_charge":325.93,"discounted_cash":130.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"BUMETANIDE 10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012755","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641600710Z","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAI .25%/50ML I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500012756","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409115902","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500012758","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155019201A","type":"NDC"}],"standard_charges":[{"gross_charge":12.73,"discounted_cash":5.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEP XR 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500012759","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078051005","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHREOMYC 125/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500012762","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781602246A","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYC 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500012763","type":"CDM"},{"code":"259","type":"RC"},{"code":"57237004460A","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN GEL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012765","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168020230","type":"NDC"}],"standard_charges":[{"gross_charge":491.96,"discounted_cash":196.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"D51/3S 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500012769","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990792509","type":"NDC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5W 100ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500012770","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990792337A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5W 50ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500012771","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990792336A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN INHN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012772","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208034205","type":"NDC"}],"standard_charges":[{"gross_charge":897.09,"discounted_cash":358.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"DEXAMETHASON 0.1% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012773","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":76.41,"discounted_cash":30.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"DICLOFENAC OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012774","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314001425A","type":"NDC"}],"standard_charges":[{"gross_charge":165.54,"discounted_cash":66.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"ESTROGEN 0.3MG T","drug_information":{"unit":"0.3","type":"ME"},"code_information":[{"code":"2500012776","type":"CDM"},{"code":"259","type":"RC"},{"code":"00046110081","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASON 44MCG INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012781","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993007896A","type":"NDC"}],"standard_charges":[{"gross_charge":584.13,"discounted_cash":233.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"GLYCERIN CHILD R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012783","type":"CDM"},{"code":"259","type":"RC"},{"code":"00132019012A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN CHILD R","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012783","type":"CDM"},{"code":"259","type":"RC"},{"code":"58980040912A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Insulin Lispro 100 Units/ml I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500012788","type":"CDM"},{"code":"259","type":"RC"},{"code":"00024592605A","type":"NDC"}],"standard_charges":[{"gross_charge":29.18,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORT 454GM CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012789","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168001516","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"IBUPROFEN 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500012792","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904791461A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOMETHACIN 75MG C","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500012793","type":"CDM"},{"code":"259","type":"RC"},{"code":"00185072060","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOCONAZOLE 2% CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012794","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168009915A","type":"NDC"}],"standard_charges":[{"gross_charge":144.76,"discounted_cash":57.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LABETALOL 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500012795","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079092820A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"L-THYROXINE 0.112MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012796","type":"CDM"},{"code":"259","type":"RC"},{"code":"42292003920A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"}]},{"description":"L-THYROXINE 0.125MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012797","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079044320","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"}]},{"description":"LIDOCAINE 2%/2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500012798","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049527A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1%/2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500012799","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409471332","type":"NDC"}],"standard_charges":[{"gross_charge":29.32,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAXZIDE 25MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012801","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505265601","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MESALAMINE 500MG R","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500012802","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092019112A","type":"NDC"}],"standard_charges":[{"gross_charge":27.3,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 500MG R","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500012802","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092019112","type":"NDC"}],"standard_charges":[{"gross_charge":27.3,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METFORMIN 850MG T","drug_information":{"unit":"850","type":"ME"},"code_information":[{"code":"2500012803","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687014301A","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012806","type":"CDM"},{"code":"259","type":"RC"},{"code":"11523432701A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"MIDAZOLAM 10/2 ORAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500012807","type":"CDM"},{"code":"259","type":"RC"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":68.3,"discounted_cash":27.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 15MG T","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500012809","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054023524A","type":"NDC"}],"standard_charges":[{"gross_charge":4.45,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPROXEN 375MG T","drug_information":{"unit":"375","type":"ME"},"code_information":[{"code":"2500012812","type":"CDM"},{"code":"259","type":"RC"},{"code":"65162018910A","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO 25MG/5ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012814","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517481025","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012815","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713067815A","type":"NDC"}],"standard_charges":[{"gross_charge":83.07,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ONDANSETRON 40MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500012816","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641607901A","type":"NDC"}],"standard_charges":[{"gross_charge":784.88,"discounted_cash":313.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500012818","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084004401","type":"NDC"}],"standard_charges":[{"gross_charge":14.53,"discounted_cash":5.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE 0.5%","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012820","type":"CDM"},{"code":"250","type":"RC"},{"code":"00225080547A","type":"NDC"}],"standard_charges":[{"gross_charge":17.42,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"PHENYTOIN 250MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500012821","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641255510A","type":"NDC"}],"standard_charges":[{"gross_charge":39.67,"discounted_cash":15.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 50MG CHEW T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500012822","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672414601A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYTRIM 10ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012824","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314062810A","type":"NDC"}],"standard_charges":[{"gross_charge":164.08,"discounted_cash":65.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"POT IODIDE 1MG L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500012825","type":"CDM"},{"code":"259","type":"RC"},{"code":"71740011230A","type":"NDC"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500012826","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"00054874025","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500012828","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591555601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORMAL SALINE 0.9% 50ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500012832","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990798436A","type":"NDC"}],"standard_charges":[{"gross_charge":30.18,"discounted_cash":12.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAG CHLORIDE 535MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012833","type":"CDM"},{"code":"259","type":"RC"},{"code":"68585000575A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPH/AMIT 4/25 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012835","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378057401","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"TRIHEXYPHENIDYL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500012836","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591533701A","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN PM T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012837","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904673151A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"SULFACETAMID/PRED OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012838","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208031705","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"VENLAFAXINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500012840","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001015600A","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 120MG T","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2500012841","type":"CDM"},{"code":"259","type":"RC"},{"code":"42291085501A","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL SR 120MG T","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2500012842","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462029201A","type":"NDC"}],"standard_charges":[{"gross_charge":7.78,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRAHYDROZOLINE OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012843","type":"CDM"},{"code":"250","type":"RC"},{"code":"74300000401","type":"NDC"}],"standard_charges":[{"gross_charge":24.22,"discounted_cash":9.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"STERILE WATER 50ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500012844","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488750","type":"NDC"}],"standard_charges":[{"gross_charge":29.16,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZAFIRLUKAST 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500012845","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084005921A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500012851","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904635161A","type":"NDC"}],"standard_charges":[{"gross_charge":78.27,"discounted_cash":31.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 5MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500012869","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"00054372250A","type":"NDC"}],"standard_charges":[{"gross_charge":18.98,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATORVASTATIN CA 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500012906","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904629061A","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM W/D 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500012907","type":"CDM"},{"code":"259","type":"RC"},{"code":"80681013900A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL 6.25MG T","drug_information":{"unit":"6.25","type":"ME"},"code_information":[{"code":"2500012908","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001015400A","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN 5MCG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500012909","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566220000B","type":"NDC"}],"standard_charges":[{"gross_charge":462.15,"discounted_cash":184.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500012910","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762502601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 300MG C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500012911","type":"CDM"},{"code":"259","type":"RC"},{"code":"49483060650A","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 400MG C","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500012912","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877022401A","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANISETRON 1MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500012914","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1626","type":"HCPCS"},{"code":"67457086301A","type":"NDC"}],"standard_charges":[{"gross_charge":715.42,"discounted_cash":286.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LATANOPROST","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012916","type":"CDM"},{"code":"259","type":"RC"},{"code":"58151041935","type":"NDC"}],"standard_charges":[{"gross_charge":92.26,"discounted_cash":36.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"MEGESTROL 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500012918","type":"CDM"},{"code":"259","type":"RC"},{"code":"64380015801A","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500012920","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079045420","type":"NDC"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORGIDE MON 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500012921","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904644961A","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 100/10 L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012922","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762502901","type":"NDC"}],"standard_charges":[{"gross_charge":52.09,"discounted_cash":20.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAMIDRONATE 30MG I","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500012923","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032418A","type":"NDC"}],"standard_charges":[{"gross_charge":65.54,"discounted_cash":26.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500012925","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079045620","type":"NDC"}],"standard_charges":[{"gross_charge":24.54,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLIMARA O.1 PATCH\\","drug_information":{"unit":"0.1","type":"ME"},"code_information":[{"code":"2500012931","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378335299","type":"NDC"}],"standard_charges":[{"gross_charge":56.44,"discounted_cash":22.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIMEPIRIDE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500012932","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079042520","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 100MG I","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500012935","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"00703574811A","type":"NDC"}],"standard_charges":[{"gross_charge":1463.24,"discounted_cash":585.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 100MG I","drug_information":{"unit":"16.7","type":"ML"},"code_information":[{"code":"2500012936","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"63323076316A","type":"NDC"}],"standard_charges":[{"gross_charge":1463.24,"discounted_cash":585.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORTADIN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500012939","type":"CDM"},{"code":"259","type":"RC"},{"code":"00067067430","type":"NDC"}],"standard_charges":[{"gross_charge":15.02,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BAZA CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012940","type":"CDM"},{"code":"259","type":"RC"},{"code":"11701004514","type":"NDC"}],"standard_charges":[{"gross_charge":550.85,"discounted_cash":220.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LIBRAX C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012941","type":"CDM"},{"code":"259","type":"RC"},{"code":"00187410010A","type":"NDC"}],"standard_charges":[{"gross_charge":26.63,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"ACARBOSE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500012942","type":"CDM"},{"code":"259","type":"RC"},{"code":"64380075906A","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENTHOL 3.6MG LOZ","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012943","type":"CDM"},{"code":"259","type":"RC"},{"code":"12546062749A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 LOZENGE"}]},{"description":"OLANZAPINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500012945","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084072301A","type":"NDC"}],"standard_charges":[{"gross_charge":53.07,"discounted_cash":21.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXAPROZIN 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500012946","type":"CDM"},{"code":"259","type":"RC"},{"code":"55111017001","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PINDOLOL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500012947","type":"CDM"},{"code":"259","type":"RC"},{"code":"62559056001A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 100/5 4OZ","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"2500012948","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802095226","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 600MG I","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500012953","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2804","type":"HCPCS"},{"code":"00068059701","type":"NDC"}],"standard_charges":[{"gross_charge":517.46,"discounted_cash":206.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZESTORETIC 10/12.5 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012954","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180051801A","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CLOPIDOGREL 75MG T","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500012965","type":"CDM"},{"code":"259","type":"RC"},{"code":"55111019630A","type":"NDC"}],"standard_charges":[{"gross_charge":29.46,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 150MG I","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500012967","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012972","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758007138","type":"NDC"}],"standard_charges":[{"gross_charge":263.94,"discounted_cash":105.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"HYDROMORPHONE 50MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500012976","type":"CDM"},{"code":"250","type":"RC"},{"code":"00703011303","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANNITOL 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500012977","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990771503A","type":"NDC"}],"standard_charges":[{"gross_charge":294.51,"discounted_cash":117.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500012978","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054873925","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYZAAR 50/125 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012979","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180021509A","type":"NDC"}],"standard_charges":[{"gross_charge":35.32,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"IBUPROFEN 20Z","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2500012980","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904530920","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 75MCG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012981","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079044120A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"IVIG IV IMMUNE GLOBULIN 10GR V","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500012982","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043710A","type":"NDC"}],"standard_charges":[{"gross_charge":2483.1,"discounted_cash":993.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DONEPEZIL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500012984","type":"CDM"},{"code":"259","type":"RC"},{"code":"62856024530A","type":"NDC"}],"standard_charges":[{"gross_charge":41.53,"discounted_cash":16.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500012992","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264230400A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHROMAGEN C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012993","type":"CDM"},{"code":"259","type":"RC"},{"code":"51991054390","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"PROCHLORPERAZIN 5/5","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500012995","type":"CDM"},{"code":"259","type":"RC"},{"code":"55390007710A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLIMARA 0.05MG","drug_information":{"unit":"0.05","type":"ME"},"code_information":[{"code":"2500012996","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378335099","type":"NDC"}],"standard_charges":[{"gross_charge":56.44,"discounted_cash":22.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STRESSTAB W/IRON","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500012997","type":"CDM"},{"code":"259","type":"RC"},{"code":"79854020105A","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"EPOETIN 20000U/ML","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500012998","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676032004A","type":"NDC"}],"standard_charges":[{"gross_charge":1653.71,"discounted_cash":661.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA CL PF 10M/I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500012999","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPTIFIBATIDE 75MG I","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500013000","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"25021040851A","type":"NDC"}],"standard_charges":[{"gross_charge":1246.76,"discounted_cash":498.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPTIFIBATIDE 20MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500013001","type":"CDM"},{"code":"636","type":"RC"},{"code":"55150021910A","type":"NDC"}],"standard_charges":[{"gross_charge":935.08,"discounted_cash":374.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NADOLOL 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500013002","type":"CDM"},{"code":"259","type":"RC"},{"code":"76385013401A","type":"NDC"}],"standard_charges":[{"gross_charge":13.47,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGEST 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500013003","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762005801","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 100/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500013004","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762311001","type":"NDC"}],"standard_charges":[{"gross_charge":54.41,"discounted_cash":21.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 500MG/50ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500013005","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469933A","type":"NDC"}],"standard_charges":[{"gross_charge":60.89,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CELECOXIB 200MG C","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500013006","type":"CDM"},{"code":"259","type":"RC"},{"code":"00025152534","type":"NDC"}],"standard_charges":[{"gross_charge":18.55,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIROFIBAN 12.5MG/250ML IV","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500013007","type":"CDM"},{"code":"636","type":"RC"},{"code":"25208000202","type":"NDC"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL","drug_information":{"unit":"3.125","type":"ME"},"code_information":[{"code":"2500013009","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084084301A","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEPRAZOLE 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500013010","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505014500","type":"NDC"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500013011","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054001920","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONTELUKAST 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500013012","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904680861A","type":"NDC"}],"standard_charges":[{"gross_charge":23.08,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500013013","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001033203A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO VISC 100ML L","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500013014","type":"CDM"},{"code":"259","type":"RC"},{"code":"72888012526A","type":"NDC"}],"standard_charges":[{"gross_charge":81.04,"discounted_cash":32.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPROZIL 125/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500013016","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180040103","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLTERODINE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500013017","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093001006A","type":"NDC"}],"standard_charges":[{"gross_charge":13.47,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLTERODINE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500013018","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093001806A","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE PER ML UNIT","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500013019","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222317A","type":"NDC"}],"standard_charges":[{"gross_charge":441.05,"discounted_cash":176.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AUGMENTIN 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500013025","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862050220A","type":"NDC"}],"standard_charges":[{"gross_charge":30.19,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RALOXIFENE 6OMG T","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500013088","type":"CDM"},{"code":"259","type":"RC"},{"code":"00002418430","type":"NDC"}],"standard_charges":[{"gross_charge":20.59,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE XR 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500013090","type":"CDM"},{"code":"259","type":"RC"},{"code":"57664060088","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 1000MG/100ML I","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500013091","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"16714069010A","type":"NDC"}],"standard_charges":[{"gross_charge":127.44,"discounted_cash":50.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Infliximab not biosimil 100mg","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500013092","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":5823.96,"discounted_cash":2329.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1GM/10ML L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500013094","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687073808A","type":"NDC"}],"standard_charges":[{"gross_charge":44.86,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500013120","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079056320","type":"NDC"}],"standard_charges":[{"gross_charge":8.07,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE XL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500013123","type":"CDM"},{"code":"259","type":"RC"},{"code":"59651078201A","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPINIROLE 0.25MG T","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2500013126","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904637361A","type":"NDC"}],"standard_charges":[{"gross_charge":8.68,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCIN ACET AQ INHN","drug_information":{"unit":"16.5","type":"GM"},"code_information":[{"code":"2500013128","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802010901A","type":"NDC"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500013442","type":"CDM"},{"code":"259","type":"RC"},{"code":"51645090501A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRBESARTAN 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500013444","type":"CDM"},{"code":"259","type":"RC"},{"code":"00024585130A","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCITROIL 0.25MCG C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500013472","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687034501A","type":"NDC"}],"standard_charges":[{"gross_charge":6.63,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"}]},{"description":"ALTEPLASE 50MG I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500013474","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004413","type":"NDC"}],"standard_charges":[{"gross_charge":4477.69,"discounted_cash":1791.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROATE NA 500MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500013481","type":"CDM"},{"code":"250","type":"RC"},{"code":"55390000710","type":"NDC"}],"standard_charges":[{"gross_charge":98.49,"discounted_cash":39.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 5ML UD","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500013482","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739016010A","type":"NDC"}],"standard_charges":[{"gross_charge":7.93,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL 12.5MG T","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2500013483","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001015100A","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETH 0.5MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500013488","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980050924A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRONESTYL 500MG INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500013748","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"76329339905A","type":"NDC"}],"standard_charges":[{"gross_charge":484.12,"discounted_cash":193.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXIN","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500013749","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084071301A","type":"NDC"}],"standard_charges":[{"gross_charge":26.83,"discounted_cash":10.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN E 1000IU","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2500013982","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904027746","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORZOXAZONE 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500013984","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591252001A","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FEXOFENADINE 180MG T","drug_information":{"unit":"180","type":"ME"},"code_information":[{"code":"2500013985","type":"CDM"},{"code":"259","type":"RC"},{"code":"69230030001A","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CITRATE T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500013988","type":"CDM"},{"code":"259","type":"RC"},{"code":"16500053507","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CLONIDINE 0.3MG PATCH","drug_information":{"unit":"0.3","type":"ME"},"code_information":[{"code":"2500013989","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378087399A","type":"NDC"}],"standard_charges":[{"gross_charge":396.55,"discounted_cash":158.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500013992","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054817425","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE 450MG/30ML I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500013993","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323029337A","type":"NDC"}],"standard_charges":[{"gross_charge":1259.23,"discounted_cash":503.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE/TIMOLOL OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014000","type":"CDM"},{"code":"259","type":"RC"},{"code":"42571014726A","type":"NDC"}],"standard_charges":[{"gross_charge":587.78,"discounted_cash":235.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"ATROVASTATIN 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500014001","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904629106A","type":"NDC"}],"standard_charges":[{"gross_charge":21.55,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CELECOXIB 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500014002","type":"CDM"},{"code":"259","type":"RC"},{"code":"58151008388","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEMOCYTE PLUS T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014003","type":"CDM"},{"code":"259","type":"RC"},{"code":"52747080060","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LISINO 20/HCTZ 12.5 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014004","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180051901A","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"FENOFIBRATE 48MG C","drug_information":{"unit":"48","type":"ME"},"code_information":[{"code":"2500014005","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378306577A","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPIRAMATE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500014006","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458064165","type":"NDC"}],"standard_charges":[{"gross_charge":37.88,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODON3E 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500014007","type":"CDM"},{"code":"259","type":"RC"},{"code":"68382080601A","type":"NDC"}],"standard_charges":[{"gross_charge":18.65,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 15MG T","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500014008","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084011901","type":"NDC"}],"standard_charges":[{"gross_charge":17.07,"discounted_cash":6.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS FUM 324MG T","drug_information":{"unit":"324","type":"ME"},"code_information":[{"code":"2500014009","type":"CDM"},{"code":"259","type":"RC"},{"code":"60258018201","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAZOSIN 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500014010","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079095920","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SARGRAMOSTIM PER 50 MCG/250","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500014011","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2820","type":"HCPCS"},{"code":"71837584305A","type":"NDC"}],"standard_charges":[{"gross_charge":993.25,"discounted_cash":397.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMIPRIL 10 MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500014013","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001043100A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIMETHOPRIM 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500014014","type":"CDM"},{"code":"259","type":"RC"},{"code":"75907004301A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALACYCLOVIR 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500014016","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173093356","type":"NDC"}],"standard_charges":[{"gross_charge":38.97,"discounted_cash":15.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIZANIDINE 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500014017","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079099820","type":"NDC"}],"standard_charges":[{"gross_charge":8.49,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPROLOL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500014018","type":"CDM"},{"code":"259","type":"RC"},{"code":"29300012613A","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FELBAMATE 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500014019","type":"CDM"},{"code":"259","type":"RC"},{"code":"00037043101","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPYRID 200/ASA 25 C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014020","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462040560A","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"MOXIFLOZCIN 400MG T","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500014021","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093738756A","type":"NDC"}],"standard_charges":[{"gross_charge":60.46,"discounted_cash":24.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIGLITOL 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500014027","type":"CDM"},{"code":"259","type":"RC"},{"code":"57664068588A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REPAGLINIDE 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2500014028","type":"CDM"},{"code":"259","type":"RC"},{"code":"57237015701A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REPAGLINIDE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500014029","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687056021A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRAZINAMIDE 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500014031","type":"CDM"},{"code":"259","type":"RC"},{"code":"70954048430A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500014032","type":"CDM"},{"code":"259","type":"RC"},{"code":"47335090288A","type":"NDC"}],"standard_charges":[{"gross_charge":15.38,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN 50MG C","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500014033","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079043820","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ITRACONAZOLE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500014034","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458029001","type":"NDC"}],"standard_charges":[{"gross_charge":53.97,"discounted_cash":21.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIFLUOPERAZINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500014035","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079057420","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR 75MG C","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500014036","type":"CDM"},{"code":"259","type":"RC"},{"code":"00004080085","type":"NDC"}],"standard_charges":[{"gross_charge":48.66,"discounted_cash":19.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPRAMAZINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500014037","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079013020","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500014038","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173073601","type":"NDC"}],"standard_charges":[{"gross_charge":140.35,"discounted_cash":56.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACET 250/ASA 250/CAFF 65 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014041","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536132601A","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"AMOXICILLIN 875MG T","drug_information":{"unit":"875","type":"ME"},"code_information":[{"code":"2500014042","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781506101","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM SR 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500014045","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054002125","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLERGONOVINE 0.2MG T","drug_information":{"unit":"0.2","type":"ME"},"code_information":[{"code":"2500014046","type":"CDM"},{"code":"259","type":"RC"},{"code":"69238160502A","type":"NDC"}],"standard_charges":[{"gross_charge":71.2,"discounted_cash":28.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOCYCLINE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500014047","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591569550a","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIZATRIPTAN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500014048","type":"CDM"},{"code":"259","type":"RC"},{"code":"69452015773A","type":"NDC"}],"standard_charges":[{"gross_charge":125.76,"discounted_cash":50.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CILOSTAZOL 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500014049","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268017615A","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIGLITOL 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500014050","type":"CDM"},{"code":"259","type":"RC"},{"code":"57664068488A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTASE ENZYME T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014051","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904522452","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MELATONIN 3MG T","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2500014053","type":"CDM"},{"code":"259","type":"RC"},{"code":"51991001406","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLCAPONE 100MG T\\","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500014054","type":"CDM"},{"code":"259","type":"RC"},{"code":"00187093801","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2500014382","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458030201","type":"NDC"}],"standard_charges":[{"gross_charge":25.86,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RALTEGRAVIR POTASSIUM 400MG TB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014388","type":"CDM"},{"code":"250","type":"RC"},{"code":"00006022761A","type":"NDC"}],"standard_charges":[{"gross_charge":142.39,"discounted_cash":56.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CHROMAGEN FORTE C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500014778","type":"CDM"},{"code":"259","type":"RC"},{"code":"51991054490","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"HEPARIN 1000U/500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500014798","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409100520","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FEXOFEN 60MG/PSEUDO 120MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015001","type":"CDM"},{"code":"259","type":"RC"},{"code":"41167431004A","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"ELDERTONIC 15ML L","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500015002","type":"CDM"},{"code":"259","type":"RC"},{"code":"89411035116A","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 500MT","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500015004","type":"CDM"},{"code":"259","type":"RC"},{"code":"00074732713A","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500015007","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904635261A","type":"NDC"}],"standard_charges":[{"gross_charge":91.55,"discounted_cash":36.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIOGLITAZONE 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500015008","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764030114","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":15.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPRAMINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500015025","type":"CDM"},{"code":"259","type":"RC"},{"code":"69584042510A","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPRAMINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500015026","type":"CDM"},{"code":"259","type":"RC"},{"code":"69584042710A","type":"NDC"}],"standard_charges":[{"gross_charge":31.51,"discounted_cash":12.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOEXIPRIL 15 MG T","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500015027","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462020801a","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONTELUKAST 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500015041","type":"CDM"},{"code":"259","type":"RC"},{"code":"33342011107A","type":"NDC"}],"standard_charges":[{"gross_charge":23.08,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE 5/METFORMIN 500 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015056","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862008201A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"OXYCODONE 5/ACET 325 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015057","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406051262","type":"NDC"}],"standard_charges":[{"gross_charge":6.76,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"METOLAZONE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500015058","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079002320","type":"NDC"}],"standard_charges":[{"gross_charge":8.63,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINO/HCT 20/25 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015060","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180052002A","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"MELOXICAM 7.5MG T","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2500015071","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268052515A","type":"NDC"}],"standard_charges":[{"gross_charge":17.57,"discounted_cash":7.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE XL 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500015072","type":"CDM"},{"code":"259","type":"RC"},{"code":"16714089401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3% 500ML I","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500015080","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338005403","type":"NDC"}],"standard_charges":[{"gross_charge":51.12,"discounted_cash":20.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 400MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500015081","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781615752","type":"NDC"}],"standard_charges":[{"gross_charge":13.69,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALENDRONATE 70MG T","drug_information":{"unit":"70","type":"ME"},"code_information":[{"code":"2500015082","type":"CDM"},{"code":"259","type":"RC"},{"code":"69097022416A","type":"NDC"}],"standard_charges":[{"gross_charge":115.52,"discounted_cash":46.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Alendronate 35mg tab","drug_information":{"unit":"35","type":"ME"},"code_information":[{"code":"2500015083","type":"CDM"},{"code":"259","type":"RC"},{"code":"10135071844A","type":"NDC"}],"standard_charges":[{"gross_charge":7.71,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE O.25MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015473","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079044420","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"}]},{"description":"AMLODIPINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500015482","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687049601A","type":"NDC"}],"standard_charges":[{"gross_charge":14.85,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIAC 5MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015483","type":"CDM"},{"code":"259","type":"RC"},{"code":"42799092101A","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"BUDESO AQUA 32MCG INHN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015493","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122038976A","type":"NDC"}],"standard_charges":[{"gross_charge":355.39,"discounted_cash":142.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"HYDROCORTISONE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500015500","type":"CDM"},{"code":"259","type":"RC"},{"code":"42543014201A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE RECOMBINANT 2MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500015540","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":878.48,"discounted_cash":351.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE CIT 60MG 2ML I","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500015600","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641616410A","type":"NDC"}],"standard_charges":[{"gross_charge":189.85,"discounted_cash":75.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE CIT 60MG/2ML L","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500015601","type":"CDM"},{"code":"259","type":"RC"},{"code":"25021060203A","type":"NDC"}],"standard_charges":[{"gross_charge":189.85,"discounted_cash":75.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAMIPEXOLE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500015622","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597019061","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TAMSO.4C","drug_information":{"unit":"0.4","type":"ME"},"code_information":[{"code":"2500015624","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739056710A","type":"NDC"}],"standard_charges":[{"gross_charge":22.28,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANDESARTAN 16MG T","drug_information":{"unit":"16","type":"ME"},"code_information":[{"code":"2500015625","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378323193A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 1000MCG/20ML I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500015673","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409909431A","type":"NDC"}],"standard_charges":[{"gross_charge":88.85,"discounted_cash":35.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHOSUXIMIDE 250 MG CAPSULE","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500015699","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762225002A","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYPROMELLOSE 25ML OPTH SOL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015702","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385000605A","type":"NDC"}],"standard_charges":[{"gross_charge":20.79,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"BUDESONIDE RESPULE","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500015703","type":"CDM"},{"code":"259","type":"RC"},{"code":"00487970101A","type":"NDC"}],"standard_charges":[{"gross_charge":31.71,"discounted_cash":12.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOX 500MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500015704","type":"CDM"},{"code":"259","type":"RC"},{"code":"50419077301A","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLESEVELAM 625MG T","drug_information":{"unit":"625","type":"ME"},"code_information":[{"code":"2500015705","type":"CDM"},{"code":"259","type":"RC"},{"code":"27808019001A","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBUR 2.5/METFOR 500 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015707","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862008105A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"IRON POLYSACCHARIDE L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500015708","type":"CDM"},{"code":"259","type":"RC"},{"code":"51991070390","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALORPROMAZINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500015709","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079051820","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLOD 5/BENAZ 20 C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015751","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180045901A","type":"NDC"}],"standard_charges":[{"gross_charge":15.09,"discounted_cash":6.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"CETIRIZINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500015782","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079059720","type":"NDC"}],"standard_charges":[{"gross_charge":11.47,"discounted_cash":4.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE 25MG/10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500015800","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143968910A","type":"NDC"}],"standard_charges":[{"gross_charge":114.71,"discounted_cash":45.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROYMYCIN XL 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500015801","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527193006A","type":"NDC"}],"standard_charges":[{"gross_charge":26.63,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORNASE ALFA INHO","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"2500015803","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7639","type":"HCPCS"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"gross_charge":385.68,"discounted_cash":154.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONTELUKAST 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500015805","type":"CDM"},{"code":"259","type":"RC"},{"code":"33342011007A","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CARBONATE 1250MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500015806","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121476605","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAVASTATIN 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500015844","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079045820","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABEPRAZOLE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500015900","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877044330A","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOMIPRAMINE 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500015901","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672401106","type":"NDC"}],"standard_charges":[{"gross_charge":27.78,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFEN/MISOPR 50MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500015902","type":"CDM"},{"code":"259","type":"RC"},{"code":"64950021810A","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC/MISOPROSTOL 50/200","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015903","type":"CDM"},{"code":"259","type":"RC"},{"code":"00025141160","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"BICALUTAMIDE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500015906","type":"CDM"},{"code":"259","type":"RC"},{"code":"47335048583A","type":"NDC"}],"standard_charges":[{"gross_charge":99.68,"discounted_cash":39.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFACLOR 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500015909","type":"CDM"},{"code":"259","type":"RC"},{"code":"61442017230A","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CREON 10 C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015913","type":"CDM"},{"code":"259","type":"RC"},{"code":"00032004770","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"DAPSONE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500015917","type":"CDM"},{"code":"259","type":"RC"},{"code":"49938010130","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPROZIL 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500015918","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180040301","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500015919","type":"CDM"},{"code":"259","type":"RC"},{"code":"00115441101","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESIPRAMINE 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500015920","type":"CDM"},{"code":"259","type":"RC"},{"code":"45963034302","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN XL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500015923","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079072220","type":"NDC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE XR 75MG C","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500015925","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084070901A","type":"NDC"}],"standard_charges":[{"gross_charge":199.19,"discounted_cash":79.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOXACILLIN 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500015927","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093312501","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTOSAN 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500015928","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458009801","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCOSAMINE 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500015929","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268037515A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCOS500/CHON400 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015930","type":"CDM"},{"code":"259","type":"RC"},{"code":"54458010022A","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"HYDROXYUREA 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500015932","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884072401","type":"NDC"}],"standard_charges":[{"gross_charge":6.74,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GARLIC 300MG C","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500015933","type":"CDM"},{"code":"259","type":"RC"},{"code":"87701040832A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMCICLOVIR 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500015934","type":"CDM"},{"code":"259","type":"RC"},{"code":"33342002507A","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHAMBUTOL 400MG T","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500015936","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084028001A","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIG 60MG T","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500015937","type":"CDM"},{"code":"259","type":"RC"},{"code":"00187301030","type":"NDC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOXIDIL 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500015938","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084020401","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOXIDIL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500015939","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084020501","type":"NDC"}],"standard_charges":[{"gross_charge":8.02,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUVOXAMINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500015940","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079099320","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANDOLAPRIL 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500015941","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180056601A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANDOLAPRIL 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500015942","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180056701A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCUVITE T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500015945","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208038760","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CEFDINIR 300MG C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500015946","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180071160","type":"NDC"}],"standard_charges":[{"gross_charge":26.95,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE 4MG GUM","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500015947","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536302923A","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE 225MG T","drug_information":{"unit":"225","type":"ME"},"code_information":[{"code":"2500016001","type":"CDM"},{"code":"259","type":"RC"},{"code":"59651025701A","type":"NDC"}],"standard_charges":[{"gross_charge":19.7,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMAZEPAM 7.5MG C","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2500016002","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406991501","type":"NDC"}],"standard_charges":[{"gross_charge":55.43,"discounted_cash":22.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10MG/ML L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500016004","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406052710","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORMOSOL R 1000 IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500016005","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990796709","type":"NDC"}],"standard_charges":[{"gross_charge":55.57,"discounted_cash":22.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL 50/CHLORTHALIDONE 25T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016006","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378206301","type":"NDC"}],"standard_charges":[{"gross_charge":8.02,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"RISEDRONATE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500016008","type":"CDM"},{"code":"259","type":"RC"},{"code":"33342010707A","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PORTACTANT 3ML VIAL","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500016144","type":"CDM"},{"code":"250","type":"RC"},{"code":"10122051003A","type":"NDC"}],"standard_charges":[{"gross_charge":3823.64,"discounted_cash":1529.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G NA 5MU I","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016500","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781615395","type":"NDC"}],"standard_charges":[{"gross_charge":172.48,"discounted_cash":68.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MMU"}]},{"description":"ESOMEPRAZOLE 40MG C","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500016502","type":"CDM"},{"code":"259","type":"RC"},{"code":"00186502031","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL 2500MG/250ML PB","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500016504","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567081110A","type":"NDC"}],"standard_charges":[{"gross_charge":1520.8,"discounted_cash":608.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5W 500ML EXCEL IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500016505","type":"CDM"},{"code":"258","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264751010a","type":"NDC"}],"standard_charges":[{"gross_charge":52.87,"discounted_cash":21.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHENAMINE 1GM T","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500016600","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862078201A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE DRIP 800MG/250ML IV","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500016606","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409781022","type":"NDC"}],"standard_charges":[{"gross_charge":204.75,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPRO 10/HCTZ 6.25 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016609","type":"CDM"},{"code":"259","type":"RC"},{"code":"29300018913A","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"OXCARBAZEPINE 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500016611","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462013801A","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXCARBAZEPINE 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500016612","type":"CDM"},{"code":"259","type":"RC"},{"code":"62756018388A","type":"NDC"}],"standard_charges":[{"gross_charge":6.46,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TANDOL/VERAP 240 Y","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016614","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462029601A","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"TRANDOL/VERAP 180MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016615","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462029501A","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"EPROSARTAN 600MG Y","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500016617","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378662993A","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500016619","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877024601A","type":"NDC"}],"standard_charges":[{"gross_charge":50.22,"discounted_cash":20.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIMEPIRIDE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500016620","type":"CDM"},{"code":"259","type":"RC"},{"code":"55111032001","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIQUIMOD 5% CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016621","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802036862A","type":"NDC"}],"standard_charges":[{"gross_charge":102.9,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"ENACAPONE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500016622","type":"CDM"},{"code":"259","type":"RC"},{"code":"27241004910A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERINDOPRIL 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500016624","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862028701A","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COD LIVER OIL C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016625","type":"CDM"},{"code":"259","type":"RC"},{"code":"54629012401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"DICLO 75/MISO 200 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016630","type":"CDM"},{"code":"259","type":"RC"},{"code":"00025142160","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"ANASTROZOLE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2500016631","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093753656A","type":"NDC"}],"standard_charges":[{"gross_charge":74.76,"discounted_cash":29.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRANBERRY 405MG C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016632","type":"CDM"},{"code":"259","type":"RC"},{"code":"57896084501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"AMOXAPINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500016634","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591571401","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500016635","type":"CDM"},{"code":"259","type":"RC"},{"code":"00004026001","type":"NDC"}],"standard_charges":[{"gross_charge":48.51,"discounted_cash":19.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEFLUNOMIDE 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500016636","type":"CDM"},{"code":"259","type":"RC"},{"code":"00088216130","type":"NDC"}],"standard_charges":[{"gross_charge":93.98,"discounted_cash":37.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAG GLUCONATE 550MG T","drug_information":{"unit":"550","type":"ME"},"code_information":[{"code":"2500016637","type":"CDM"},{"code":"259","type":"RC"},{"code":"58487001751A","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLTERODINE LA 4MG C","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500016640","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904659304A","type":"NDC"}],"standard_charges":[{"gross_charge":22.96,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUXOZAMINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500016641","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079099220","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MALTREXONE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500016643","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406117003","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"B COMPLEX/C/FOLIC T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016647","type":"CDM"},{"code":"259","type":"RC"},{"code":"60258016001","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"SEVELAMER CARBONATE 800MG T","drug_information":{"unit":"800","type":"ME"},"code_information":[{"code":"2500016648","type":"CDM"},{"code":"259","type":"RC"},{"code":"58468013301","type":"NDC"}],"standard_charges":[{"gross_charge":32.21,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNA-S T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016651","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739043202A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"FERROUS SULF SR T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500016652","type":"CDM"},{"code":"259","type":"RC"},{"code":"79854007749A","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"POTASSIUM CL 20MEQ/100ML PB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500016655","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070548A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PLEGISOL 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500016700","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409796905","type":"NDC"}],"standard_charges":[{"gross_charge":226.89,"discounted_cash":90.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPHCON A OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500017003","type":"CDM"},{"code":"250","type":"RC"},{"code":"00065008515","type":"NDC"}],"standard_charges":[{"gross_charge":27.78,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"LORAZEPAM 2MG L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500017004","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054353244","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MURO 128 5% OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500017048","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208038555A","type":"NDC"}],"standard_charges":[{"gross_charge":74.09,"discounted_cash":29.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MURO 128 5% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500017049","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208027715A","type":"NDC"}],"standard_charges":[{"gross_charge":82.11,"discounted_cash":32.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"TENECTEPLASE 50MG I","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500017050","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242017601A","type":"NDC"}],"standard_charges":[{"gross_charge":8257.34,"discounted_cash":3302.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TALC 3 GRAM VIAL","drug_information":{"unit":"3","type":"GM"},"code_information":[{"code":"2500017051","type":"CDM"},{"code":"250","type":"RC"},{"code":"62327033343","type":"NDC"}],"standard_charges":[{"gross_charge":431.79,"discounted_cash":172.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOREPINEPHRINE 8MG/250ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500017221","type":"CDM"},{"code":"250","type":"RC"},{"code":"52533021718","type":"NDC"}],"standard_charges":[{"gross_charge":46.31,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOREPINEPHRINE 16MG/250ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500017222","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567064210A","type":"NDC"}],"standard_charges":[{"gross_charge":189.85,"discounted_cash":75.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCN 2% W EPINEP 20ML VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500017481","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323048927A","type":"NDC"}],"standard_charges":[{"gross_charge":89.52,"discounted_cash":35.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM W/VIT D 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500017500","type":"CDM"},{"code":"259","type":"RC"},{"code":"10006070038A","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 1GM PKT","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500017501","type":"CDM"},{"code":"250","type":"RC"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBINAFINE 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500017502","type":"CDM"},{"code":"259","type":"RC"},{"code":"51991052601A","type":"NDC"}],"standard_charges":[{"gross_charge":79.98,"discounted_cash":31.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 500MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500017600","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600121A","type":"NDC"}],"standard_charges":[{"gross_charge":273.39,"discounted_cash":109.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500017601","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079045520","type":"NDC"}],"standard_charges":[{"gross_charge":24.54,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 5/HCTZ 12.5 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500017602","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672404501","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"FENTANYL 100MCG/2ML VIAL","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500017800","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080602A","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE XL 90MG T","drug_information":{"unit":"90","type":"ME"},"code_information":[{"code":"2500018001","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268059915A","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ILMISARTAN 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500018002","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597004037","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 100MG/2ML I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500018003","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457051625A","type":"NDC"}],"standard_charges":[{"gross_charge":85.43,"discounted_cash":34.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500018006","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687034901A","type":"NDC"}],"standard_charges":[{"gross_charge":23.95,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN GLARGINE 300 UNIT/ML","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500018027","type":"CDM"},{"code":"259","type":"RC"},{"code":"00024586903A","type":"NDC"}],"standard_charges":[{"gross_charge":493.15,"discounted_cash":197.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPROXEN 125MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500018030","type":"CDM"},{"code":"259","type":"RC"},{"code":"68134020116A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FELODIPINE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500018046","type":"CDM"},{"code":"259","type":"RC"},{"code":"53489036801","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOD PHOS 20MEQ/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500018048","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409739172A","type":"NDC"}],"standard_charges":[{"gross_charge":39.87,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5S20K IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500018050","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990710709","type":"NDC"}],"standard_charges":[{"gross_charge":98.86,"discounted_cash":39.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NS S40K IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500018051","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990711609","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE 100MG/5ML SYR","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500018161","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781341195A","type":"NDC"}],"standard_charges":[{"gross_charge":109.26,"discounted_cash":43.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METFORMIN XR 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500018500","type":"CDM"},{"code":"259","type":"RC"},{"code":"70010049105A","type":"NDC"}],"standard_charges":[{"gross_charge":17.68,"discounted_cash":7.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE 0.5% 30ML I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500018501","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTER ESTROG/METHYLTEST T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500018504","type":"CDM"},{"code":"259","type":"RC"},{"code":"11528001001","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CARBOPLATIN 450MG I","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"2500018505","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029534A","type":"NDC"}],"standard_charges":[{"gross_charge":370.21,"discounted_cash":148.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE 1GM I","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500018506","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"25021023550A","type":"NDC"}],"standard_charges":[{"gross_charge":1869.57,"discounted_cash":747.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SANDUMMUNE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500018507","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"60505013400A","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SANDUMMUNE 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500018508","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"68084087925A","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVAPROEX ER 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500018509","type":"CDM"},{"code":"259","type":"RC"},{"code":"00074740213A","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLAVOXATE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500018510","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574011501","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 20MG/100ML I","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500018513","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"55150028710A","type":"NDC"}],"standard_charges":[{"gross_charge":74.95,"discounted_cash":29.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 20MG/20ML I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500018514","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9999","type":"HCPCS"},{"code":"00143970910A","type":"NDC"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM 40MEG/100ML PB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500018515","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707726A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE 50MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500018516","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905A","type":"NDC"}],"standard_charges":[{"gross_charge":69.99,"discounted_cash":28.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PLOGLITAZONE 15MG T","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500018523","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764015104","type":"NDC"}],"standard_charges":[{"gross_charge":18.55,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 300MG C","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500018526","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084024401","type":"NDC"}],"standard_charges":[{"gross_charge":34.36,"discounted_cash":13.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGIN 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500018590","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173063302","type":"NDC"}],"standard_charges":[{"gross_charge":21.21,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BECAPLERMIN 0.01% GEL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500018591","type":"CDM"},{"code":"259","type":"RC"},{"code":"50484081015","type":"NDC"}],"standard_charges":[{"gross_charge":1129.0,"discounted_cash":451.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"DOPAMINE 400MG/250ML BAG","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500018592","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409780922","type":"NDC"}],"standard_charges":[{"gross_charge":227.43,"discounted_cash":90.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTIC/SALME 500/50 INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500018593","type":"CDM"},{"code":"259","type":"RC"},{"code":"66993058697A","type":"NDC"}],"standard_charges":[{"gross_charge":1233.3,"discounted_cash":493.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"FLUTIC/SALME 250/50 INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500018594","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173069600A","type":"NDC"}],"standard_charges":[{"gross_charge":864.2,"discounted_cash":345.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"FLUTIC/SALME 100/50 INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500018595","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173069500A","type":"NDC"}],"standard_charges":[{"gross_charge":864.2,"discounted_cash":345.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"PIOGLITAZONE 45 MG T","drug_information":{"unit":"45","type":"ME"},"code_information":[{"code":"2500018596","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764045124","type":"NDC"}],"standard_charges":[{"gross_charge":41.67,"discounted_cash":16.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE 2/EPI 0.5% 50ML VL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500018818","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046357A","type":"NDC"}],"standard_charges":[{"gross_charge":75.23,"discounted_cash":30.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLENE BLUE 0.5% INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500018819","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517037405A","type":"NDC"}],"standard_charges":[{"gross_charge":929.8,"discounted_cash":371.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CICLESONIDE 80 MCG INHALER","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500018820","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515071101A","type":"NDC"}],"standard_charges":[{"gross_charge":1033.76,"discounted_cash":413.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"PROMETHAZINE 12.5MG TABS","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2500018971","type":"CDM"},{"code":"259","type":"RC"},{"code":"65162074510A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5MG CAP","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2500018972","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079077620A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIV/EPINE 0.75% 30ML INJ","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500019903","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323046037A","type":"NDC"}],"standard_charges":[{"gross_charge":48.18,"discounted_cash":19.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Acetaminophen 500mg/50ml bag","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500021653","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264405080A","type":"NDC"}],"standard_charges":[{"gross_charge":51.79,"discounted_cash":20.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN/PREDNISOLONE OPHTH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500023006","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023006604A","type":"NDC"}],"standard_charges":[{"gross_charge":584.33,"discounted_cash":233.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"EPHEDRINE 25MG/5ML SYRINGE","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500023033","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641623610A","type":"NDC"}],"standard_charges":[{"gross_charge":37.04,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"R.E.C.K. 50ML SYRINGE","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500023921","type":"CDM"},{"code":"250","type":"RC"},{"code":"70092143350A","type":"NDC"}],"standard_charges":[{"gross_charge":251.17,"discounted_cash":100.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDODRINE 2.5MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500024103","type":"CDM"},{"code":"250","type":"RC"},{"code":"00245021111A","type":"NDC"}],"standard_charges":[{"gross_charge":8.02,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDODRINE 10MG TAB","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500024104","type":"CDM"},{"code":"250","type":"RC"},{"code":"00245021311A","type":"NDC"}],"standard_charges":[{"gross_charge":48.63,"discounted_cash":19.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANGIOTENSIN II ACETATE VIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500025550","type":"CDM"},{"code":"250","type":"RC"},{"code":"68547050102A","type":"NDC"}],"standard_charges":[{"gross_charge":5438.0,"discounted_cash":2175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIRAGLUTIED 18MG/3ML PEN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500025782","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169406012B","type":"NDC"}],"standard_charges":[{"gross_charge":1838.31,"discounted_cash":735.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1% PF 5ML V","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500030144","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049297B","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 40% 2 ML SYRINGE","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"2500030337","type":"CDM"},{"code":"250","type":"RC"},{"code":"54758000628A","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTAMIDINE 300MG/15ML UD","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2500030338","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2545","type":"HCPCS"},{"code":"63323087715A","type":"NDC"}],"standard_charges":[{"gross_charge":832.3,"discounted_cash":332.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFINITY 2 ML VL","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500030341","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001101A","type":"NDC"}],"standard_charges":[{"gross_charge":714.25,"discounted_cash":285.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DURVALUMAB 120MG/2.4ML VIAL","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"2500030448","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"00310450012A","type":"NDC"}],"standard_charges":[{"gross_charge":4489.56,"discounted_cash":1795.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DURVALUMAB 500MG/10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500030449","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"00310461150A","type":"NDC"}],"standard_charges":[{"gross_charge":18645.2,"discounted_cash":7458.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45% 50ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500031092","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323062650A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1%/EPI 1:100K 30ML V","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500032221","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409317802A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRELEGY ELLIPTA INHALER","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500036201","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173088714A","type":"NDC"}],"standard_charges":[{"gross_charge":1231.8,"discounted_cash":492.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"Dorzolamide/Timolol 1 EA UD","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500041001","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584060430A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMALOG 75/25 I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500041442","type":"CDM"},{"code":"259","type":"RC"},{"code":"00002751101A","type":"NDC"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL SUC XL 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500041443","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904632261A","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500041444","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762435501A","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 6 GM/30 ML I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500041445","type":"CDM"},{"code":"250","type":"RC"},{"code":"66220020730A","type":"NDC"}],"standard_charges":[{"gross_charge":866.5,"discounted_cash":346.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSULFAN BLUE 50MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500041740","type":"CDM"},{"code":"250","type":"RC"},{"code":"J1820","type":"HCPCS"},{"code":"67457022005A","type":"NDC"}],"standard_charges":[{"gross_charge":1767.7,"discounted_cash":707.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIMEPIRIDE 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500047822","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079042620","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM 125MG I","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"2500048793","type":"CDM"},{"code":"250","type":"RC"},{"code":"55390056530A","type":"NDC"}],"standard_charges":[{"gross_charge":107.66,"discounted_cash":43.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tobramycin 300mg/5mL Updraft","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500052796","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756060456A","type":"NDC"}],"standard_charges":[{"gross_charge":582.08,"discounted_cash":232.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Diazepam 20mg Rectal Gel Kit","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500065520","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065520A","type":"NDC"}],"standard_charges":[{"gross_charge":1440.95,"discounted_cash":576.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Precedex 1000mcg/10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500065521","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069075904A","type":"NDC"}],"standard_charges":[{"gross_charge":655.51,"discounted_cash":262.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE OINT 15 GM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500070589","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168000380A","type":"NDC"}],"standard_charges":[{"gross_charge":220.89,"discounted_cash":88.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"FENOFIBRATE 145MG T","drug_information":{"unit":"145","type":"ME"},"code_information":[{"code":"2500075001","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378306605A","type":"NDC"}],"standard_charges":[{"gross_charge":17.12,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALMETEROL DISKUS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075002","type":"CDM"},{"code":"250","type":"RC"},{"code":"00173052100A","type":"NDC"}],"standard_charges":[{"gross_charge":380.86,"discounted_cash":152.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"AMLODIPINE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500075004","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877019790A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIMIDONE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500075005","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084020201","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPROZIL 250/5 L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500075006","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180040203","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION SR 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500075007","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084069701A","type":"NDC"}],"standard_charges":[{"gross_charge":14.33,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHIMAZOLE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500075008","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687068001A","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOSARTAN K 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500075009","type":"CDM"},{"code":"259","type":"RC"},{"code":"78206012101A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 22GM OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075010","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462018022A","type":"NDC"}],"standard_charges":[{"gross_charge":53.4,"discounted_cash":21.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NASONEX NA","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075012","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505083001A","type":"NDC"}],"standard_charges":[{"gross_charge":426.01,"discounted_cash":170.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 40MG C","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500075013","type":"CDM"},{"code":"259","type":"RC"},{"code":"43598051030A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE 500MCG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075014","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641617610A","type":"NDC"}],"standard_charges":[{"gross_charge":551.12,"discounted_cash":220.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENCICLOVIR 1% CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075015","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378972055Z","type":"NDC"}],"standard_charges":[{"gross_charge":135.44,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"KETOCONAZOLE SHAMPOO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075016","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802046564","type":"NDC"}],"standard_charges":[{"gross_charge":153.92,"discounted_cash":61.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"RISPERIDONE 1MG/ML L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075017","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458030503","type":"NDC"}],"standard_charges":[{"gross_charge":31.09,"discounted_cash":12.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAMIDEXOLE 0.125MG T","drug_information":{"unit":"0.125","type":"ME"},"code_information":[{"code":"2500075018","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597018390","type":"NDC"}],"standard_charges":[{"gross_charge":17.14,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG C","drug_information":{"unit":"1.5","type":"ME"},"code_information":[{"code":"2500075019","type":"CDM"},{"code":"259","type":"RC"},{"code":"62756014586A","type":"NDC"}],"standard_charges":[{"gross_charge":22.35,"discounted_cash":8.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE TARTRATE 3 MG CAP","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2500075020","type":"CDM"},{"code":"259","type":"RC"},{"code":"62756014686A","type":"NDC"}],"standard_charges":[{"gross_charge":22.35,"discounted_cash":8.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 30GM OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075022","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802004811","type":"NDC"}],"standard_charges":[{"gross_charge":33.79,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"BIMATOPROST 2.5ML OPS\\","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075023","type":"CDM"},{"code":"250","type":"RC"},{"code":"00023320503A","type":"NDC"}],"standard_charges":[{"gross_charge":274.35,"discounted_cash":109.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CLOTRIMAZOLE/BETAMETH LOTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075026","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672130803A","type":"NDC"}],"standard_charges":[{"gross_charge":275.52,"discounted_cash":110.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"HAEMOPHILUS B CONJ I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500075031","type":"CDM"},{"code":"636","type":"RC"},{"code":"90648","type":"HCPCS"},{"code":"5816081601A","type":"NDC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE 80 GM OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075032","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168000380","type":"NDC"}],"standard_charges":[{"gross_charge":172.48,"discounted_cash":68.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ENOXAPARIN 150MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075035","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548560700A","type":"NDC"}],"standard_charges":[{"gross_charge":169.77,"discounted_cash":67.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REPAGLINIDE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500075037","type":"CDM"},{"code":"259","type":"RC"},{"code":"57237015901A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM CD 360MG C","drug_information":{"unit":"360","type":"ME"},"code_information":[{"code":"2500075038","type":"CDM"},{"code":"259","type":"RC"},{"code":"50742025290A","type":"NDC"}],"standard_charges":[{"gross_charge":20.41,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HC OTIC","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075041","type":"CDM"},{"code":"259","type":"RC"},{"code":"66758008770","type":"NDC"}],"standard_charges":[{"gross_charge":495.08,"discounted_cash":198.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"TRAMADOL/ACET 37.5MG/325MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075042","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378808801A","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"FONDAPARINUX 2.5MG/0.5ML I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500075044","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457059210","type":"NDC"}],"standard_charges":[{"gross_charge":319.5,"discounted_cash":127.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELEGILINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500075045","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505005501","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN 100MG I","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500075046","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457052810A","type":"NDC"}],"standard_charges":[{"gross_charge":113.91,"discounted_cash":45.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMIPRIL 1.25MG C","drug_information":{"unit":"1.25","type":"ME"},"code_information":[{"code":"2500075047","type":"CDM"},{"code":"259","type":"RC"},{"code":"68382014406A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL CYPIONATE 5MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075048","type":"CDM"},{"code":"250","type":"RC"},{"code":"00009027101","type":"NDC"}],"standard_charges":[{"gross_charge":115.76,"discounted_cash":46.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN/POLYMIXIN B OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075049","type":"CDM"},{"code":"250","type":"RC"},{"code":"00574402135Z","type":"NDC"}],"standard_charges":[{"gross_charge":157.28,"discounted_cash":62.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MIRTAZAPINE 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500075051","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079008720","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORATADINE 10MG/10ML L","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500075052","type":"CDM"},{"code":"259","type":"RC"},{"code":"24385053126","type":"NDC"}],"standard_charges":[{"gross_charge":22.02,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN 40 000U/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075053","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676034001A","type":"NDC"}],"standard_charges":[{"gross_charge":5331.15,"discounted_cash":2132.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2500075054","type":"CDM"},{"code":"259","type":"RC"},{"code":"50474059440","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"novoLOG 100U/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075055","type":"CDM"},{"code":"250","type":"RC"},{"code":"00169750111","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 20MG/ML L","drug_information":{"unit":"0.75","type":"ML"},"code_information":[{"code":"2500075057","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808008201A","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 1% SOL","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2500075058","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168020160","type":"NDC"}],"standard_charges":[{"gross_charge":198.45,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESCITALOPRAM 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500075060","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456201001A","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE CR 12.5 T","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2500075061","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505366803","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON ODT 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500075062","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001024617A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON ODT 8MG T","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2500075063","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0162","type":"HCPCS"},{"code":"68462015813A","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLAVULANATE/AMOXIC 600MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500075066","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093867578","type":"NDC"}],"standard_charges":[{"gross_charge":18.55,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALANCED SALT 15ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075067","type":"CDM"},{"code":"259","type":"RC"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":98.82,"discounted_cash":39.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"BETAMETHASONE VAL OINT 45 GM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075068","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168003346","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"BETHANECHOL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500075069","type":"CDM"},{"code":"259","type":"RC"},{"code":"65162057110","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOMIPRAMINE 50MG C","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500075070","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672401206","type":"NDC"}],"standard_charges":[{"gross_charge":33.32,"discounted_cash":13.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 300MG/5ML UD","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500075073","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 20MG/5ML UD","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500075075","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687084577A","type":"NDC"}],"standard_charges":[{"gross_charge":45.28,"discounted_cash":18.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500075077","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739032810A","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM 42MCG SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075078","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208039915","type":"NDC"}],"standard_charges":[{"gross_charge":296.82,"discounted_cash":118.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"Insulin GLARGINE 100U/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075079","type":"CDM"},{"code":"250","type":"RC"},{"code":"83257001411A","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZONE/BETAMETHASONE45GM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075081","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168025846","type":"NDC"}],"standard_charges":[{"gross_charge":285.94,"discounted_cash":114.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NIACIN 750MG T","drug_information":{"unit":"750","type":"ME"},"code_information":[{"code":"2500075082","type":"CDM"},{"code":"259","type":"RC"},{"code":"59651001990A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500075083","type":"CDM"},{"code":"259","type":"RC"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"gross_charge":28.57,"discounted_cash":11.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIAGABINE 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500075087","type":"CDM"},{"code":"259","type":"RC"},{"code":"72205008530A","type":"NDC"}],"standard_charges":[{"gross_charge":23.91,"discounted_cash":9.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLTERODINE LA 2MG C","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2500075088","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378340293A","type":"NDC"}],"standard_charges":[{"gross_charge":24.02,"discounted_cash":9.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE 75MG T","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2500075090","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001016000A","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 15MG/0.6ML BTL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500075091","type":"CDM"},{"code":"259","type":"RC"},{"code":"71399748005A","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC 10MG/10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500075092","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409409001","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN 80MG/HCTZ 12.5MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500075096","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078031534A","type":"NDC"}],"standard_charges":[{"gross_charge":14.81,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NS (RT) 7% 4ML VIAL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500083490","type":"CDM"},{"code":"250","type":"RC"},{"code":"83490030760A","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORMAL SALINE ADD-VANTAGE 100M","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500091137","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338055318A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN 25GM/500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2500156700","type":"CDM"},{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031050","type":"NDC"}],"standard_charges":[{"gross_charge":897.67,"discounted_cash":359.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 10ML SOL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156701","type":"CDM"},{"code":"259","type":"RC"},{"code":"70756060915A","type":"NDC"}],"standard_charges":[{"gross_charge":435.71,"discounted_cash":174.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"FOSINOPRIL 20 MG - T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500156703","type":"CDM"},{"code":"259","type":"RC"},{"code":"43547038709A","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALANTAMINE 4 MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500156705","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084072921A","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANDESARTAN 4 MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2500156706","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884065809A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES 1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156707","type":"CDM"},{"code":"636","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"50632001001A","type":"NDC"}],"standard_charges":[{"gross_charge":1557.09,"discounted_cash":622.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLOPATADINE 0.1% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156708","type":"CDM"},{"code":"259","type":"RC"},{"code":"58602000640A","type":"NDC"}],"standard_charges":[{"gross_charge":171.62,"discounted_cash":68.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"AMLODI 5/BENAZ 10 C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156709","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180075601A","type":"NDC"}],"standard_charges":[{"gross_charge":14.29,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"BETAMETHASONE 0.1% OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156711","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168003315","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"GUAIFEN/PSEUDO 5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156713","type":"CDM"},{"code":"259","type":"RC"},{"code":"64543004404","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INTERLEUKIN-2 22MIU I","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156717","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9015","type":"HCPCS"},{"code":"73776002201A","type":"NDC"}],"standard_charges":[{"gross_charge":8276.3,"discounted_cash":3310.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 MMU"}]},{"description":"ACYCLOVIR 200MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156723","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378871273a","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 17GM POW","drug_information":{"unit":"17","type":"GM"},"code_information":[{"code":"2500156724","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687043192A","type":"NDC"}],"standard_charges":[{"gross_charge":9.99,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN IMMUNE 38MG I","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500156730","type":"CDM"},{"code":"636","type":"RC"},{"code":"50633012011","type":"NDC"}],"standard_charges":[{"gross_charge":1774.64,"discounted_cash":709.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NATEGLINIDE 120MG T","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2500156732","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687068421A","type":"NDC"}],"standard_charges":[{"gross_charge":9.64,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500156734","type":"CDM"},{"code":"259","type":"RC"},{"code":"50474059540","type":"NDC"}],"standard_charges":[{"gross_charge":22.35,"discounted_cash":8.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOREMIFENE 60MG T","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500156735","type":"CDM"},{"code":"259","type":"RC"},{"code":"42747032730","type":"NDC"}],"standard_charges":[{"gross_charge":65.05,"discounted_cash":26.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE ER 37.5MG C","drug_information":{"unit":"37.5","type":"ME"},"code_information":[{"code":"2500156739","type":"CDM"},{"code":"259","type":"RC"},{"code":"00008083703","type":"NDC"}],"standard_charges":[{"gross_charge":21.98,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESLORATADINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500156740","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180015301A","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORAMPHENICOL 1 GM I","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500156742","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0720","type":"HCPCS"},{"code":"63323001115","type":"NDC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORAPRED 15 MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156743","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121075908A","type":"NDC"}],"standard_charges":[{"gross_charge":13.81,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN 5MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156745","type":"CDM"},{"code":"259","type":"RC"},{"code":"62135052047A","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE 30 GM CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156746","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802006435A","type":"NDC"}],"standard_charges":[{"gross_charge":18.47,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MODAFINIL 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500156747","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084062121A","type":"NDC"}],"standard_charges":[{"gross_charge":125.21,"discounted_cash":50.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500156750","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173064255","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIMENHYDRINATE 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2500156753","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904205159","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 40MG/0.4L I","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"2500156755","type":"CDM"},{"code":"250","type":"RC"},{"code":"00548560200A","type":"NDC"}],"standard_charges":[{"gross_charge":45.22,"discounted_cash":18.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOXINE 100MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156756","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":23.1,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 5ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156758","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505056000A","type":"NDC"}],"standard_charges":[{"gross_charge":99.38,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"LIDOCAINE 5% PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156759","type":"CDM"},{"code":"259","type":"RC"},{"code":"42291047730A","type":"NDC"}],"standard_charges":[{"gross_charge":33.57,"discounted_cash":13.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"DEXAMETHASONE 1 MG/ML L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156760","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054317644","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN 30 MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156761","type":"CDM"},{"code":"259","type":"RC"},{"code":"63824017563","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAVASTATIN 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2500156762","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079078220","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 600MG IVPB","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"2500156764","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"55150024251A","type":"NDC"}],"standard_charges":[{"gross_charge":396.6,"discounted_cash":158.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHOTERICIN B LIPOSOME 50MG I","drug_information":{"unit":"12.5","type":"ML"},"code_information":[{"code":"2500156765","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0289","type":"HCPCS"},{"code":"00469305130","type":"NDC"}],"standard_charges":[{"gross_charge":1348.44,"discounted_cash":539.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 10MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156766","type":"CDM"},{"code":"250","type":"RC"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROTHIAZIDE 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500156768","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"63323065820A","type":"NDC"}],"standard_charges":[{"gross_charge":1484.64,"discounted_cash":593.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GARAMYCIN GENTAMICIN INJ","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500156770","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050748","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SECRETIN 16MCG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500156771","type":"CDM"},{"code":"250","type":"RC"},{"code":"67066000501A","type":"NDC"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZELASTINE INHN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156772","type":"CDM"},{"code":"259","type":"RC"},{"code":"00280006501A","type":"NDC"}],"standard_charges":[{"gross_charge":317.19,"discounted_cash":126.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"BENZOCAINE 0.33OZ TUBE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156773","type":"CDM"},{"code":"259","type":"RC"},{"code":"00573021825A","type":"NDC"}],"standard_charges":[{"gross_charge":22.77,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CEFOXITIN 2 GM VIAL","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500156774","type":"CDM"},{"code":"250","type":"RC"},{"code":"00143987725A","type":"NDC"}],"standard_charges":[{"gross_charge":99.19,"discounted_cash":39.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFEROXIMINE 2 GRAM I","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500156777","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"00409233725","type":"NDC"}],"standard_charges":[{"gross_charge":186.67,"discounted_cash":74.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 600MG PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500156779","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781328909A","type":"NDC"}],"standard_charges":[{"gross_charge":65.78,"discounted_cash":26.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 300 MG PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500156780","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781328809A","type":"NDC"}],"standard_charges":[{"gross_charge":40.06,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC GLUCONATE COMPLEX 62.5M","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156781","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00024279210A","type":"NDC"}],"standard_charges":[{"gross_charge":181.11,"discounted_cash":72.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINO ACIDS 20% I","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500156782","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338049906A","type":"NDC"}],"standard_charges":[{"gross_charge":1039.0,"discounted_cash":415.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARICALCITOL 5MCG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156783","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"00074165801","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 750 MG PB","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"2500156784","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409015224C","type":"NDC"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 250 MG PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500156785","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409015224B","type":"NDC"}],"standard_charges":[{"gross_charge":170.17,"discounted_cash":68.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 1 GRAM PB","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"2500156786","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409015224A","type":"NDC"}],"standard_charges":[{"gross_charge":336.87,"discounted_cash":134.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECURONIUM 20 MG PB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500156787","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335093244A","type":"NDC"}],"standard_charges":[{"gross_charge":190.72,"discounted_cash":76.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE TOP 30 GM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156790","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536126595A","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"FLUCONAZOLE 100MG PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500156791","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338604648A","type":"NDC"}],"standard_charges":[{"gross_charge":406.33,"discounted_cash":162.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500156792","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0872","type":"HCPCS"},{"code":"43598041311A","type":"NDC"}],"standard_charges":[{"gross_charge":142.39,"discounted_cash":56.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN 20000U KIT","drug_information":{"unit":"20000","type":"UN"},"code_information":[{"code":"2500156795","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793021721","type":"NDC"}],"standard_charges":[{"gross_charge":1481.74,"discounted_cash":592.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 20MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156796","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016505A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1% 30ML PF I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500156798","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409427902A","type":"NDC"}],"standard_charges":[{"gross_charge":29.01,"discounted_cash":11.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1% 30ML PF I","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2500156798","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":29.01,"discounted_cash":11.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN 20 000U VIAL","drug_information":{"unit":"20000","type":"UN"},"code_information":[{"code":"2500156799","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793021720","type":"NDC"}],"standard_charges":[{"gross_charge":1412.8,"discounted_cash":565.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN 1 GRAM PB","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500156802","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910B","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE .1% EPIDURAL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500156808","type":"CDM"},{"code":"250","type":"RC"},{"code":"70004006040","type":"NDC"}],"standard_charges":[{"gross_charge":94.93,"discounted_cash":37.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM ADV 100MG I","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500156809","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409435003","type":"NDC"}],"standard_charges":[{"gross_charge":54.48,"discounted_cash":21.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 800MG/4ML INHS","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156811","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517760425B","type":"NDC"}],"standard_charges":[{"gross_charge":72.73,"discounted_cash":29.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 800MG/4ML INHS","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156811","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517760425","type":"NDC"}],"standard_charges":[{"gross_charge":72.73,"discounted_cash":29.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 200MG PB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500156812","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"00409230024A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEVIMELINE 30MG C","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500156814","type":"CDM"},{"code":"259","type":"RC"},{"code":"16571065710A","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 4 GRAM T","drug_information":{"unit":"4","type":"GM"},"code_information":[{"code":"2500156815","type":"CDM"},{"code":"259","type":"RC"},{"code":"21292000431A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 2 GRAM I","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500156816","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00143985625A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 2 GRAM I","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500156817","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567023610A","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN 1 GRAM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500156818","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910A","type":"NDC"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1 GRAM ADV","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500156819","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"70860010520A","type":"NDC"}],"standard_charges":[{"gross_charge":42.72,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN 25MG C","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2500156820","type":"CDM"},{"code":"259","type":"RC"},{"code":"58151023677","type":"NDC"}],"standard_charges":[{"gross_charge":13.43,"discounted_cash":5.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARICALCITOL 2MCG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156821","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2501","type":"HCPCS"},{"code":"00074463701","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 1000MG R","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2500156823","type":"CDM"},{"code":"259","type":"RC"},{"code":"58914050156","type":"NDC"}],"standard_charges":[{"gross_charge":57.89,"discounted_cash":23.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSCYAMINE UP TO 0.25 MG UNIT","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156825","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1980","type":"HCPCS"},{"code":"54288011105A","type":"NDC"}],"standard_charges":[{"gross_charge":339.55,"discounted_cash":135.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.25MG/2ML RESPULE","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500156826","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7626","type":"HCPCS"},{"code":"00093681573","type":"NDC"}],"standard_charges":[{"gross_charge":44.67,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISATRACURIUM 10MG/5ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500156829","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074438010","type":"NDC"}],"standard_charges":[{"gross_charge":113.58,"discounted_cash":45.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 20MG/4ML I","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500156830","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409233934A","type":"NDC"}],"standard_charges":[{"gross_charge":38.49,"discounted_cash":15.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156831","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474000263","type":"NDC"}],"standard_charges":[{"gross_charge":248.24,"discounted_cash":99.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BERACTANT 25MG/8ML VIAL","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"2500156833","type":"CDM"},{"code":"250","type":"RC"},{"code":"00074104008","type":"NDC"}],"standard_charges":[{"gross_charge":1438.0,"discounted_cash":575.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANITUMUMAB 400MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500156834","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":28240.12,"discounted_cash":11296.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 100MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156837","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431A","type":"NDC"}],"standard_charges":[{"gross_charge":216.38,"discounted_cash":86.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARICALCITOL 1 MCG C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156838","type":"CDM"},{"code":"259","type":"RC"},{"code":"00074903630","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":18.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"}]},{"description":"FLUCONAZOLE 150MG PB","drug_information":{"unit":"75","type":"ML"},"code_information":[{"code":"2500156840","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021018482B","type":"NDC"}],"standard_charges":[{"gross_charge":445.68,"discounted_cash":178.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPROSTADIL 500MCG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156842","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"00009316906","type":"NDC"}],"standard_charges":[{"gross_charge":1513.02,"discounted_cash":605.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TALC 4 GRAM VIAL","drug_information":{"unit":"4","type":"GM"},"code_information":[{"code":"2500156843","type":"CDM"},{"code":"250","type":"RC"},{"code":"6232744404","type":"NDC"}],"standard_charges":[{"gross_charge":935.08,"discounted_cash":374.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BROMFENAC .09 OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156846","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332050817A","type":"NDC"}],"standard_charges":[{"gross_charge":686.02,"discounted_cash":274.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"DOCUSATE SODIUM ENEMA","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156848","type":"CDM"},{"code":"250","type":"RC"},{"code":"17433987603","type":"NDC"}],"standard_charges":[{"gross_charge":10.87,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMSIROLIMUS 25MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156849","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"00008117901","type":"NDC"}],"standard_charges":[{"gross_charge":3434.68,"discounted_cash":1373.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME OPTH 1MG/0.1ML I","drug_information":{"unit":"0.1","type":"ML"},"code_information":[{"code":"2500156850","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00143997722C","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":16.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 1GR/100ML PB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500156851","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567041024A","type":"NDC"}],"standard_charges":[{"gross_charge":35.12,"discounted_cash":14.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE  2% W/EPI 1:100 000","drug_information":{"unit":"1.7","type":"ML"},"code_information":[{"code":"2500156852","type":"CDM"},{"code":"250","type":"RC"},{"code":"66312018116A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION 20% 250ML I","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500156855","type":"CDM"},{"code":"250","type":"RC"},{"code":"00264446030A","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":24.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARFORMOTEROL 15MCG/2ML INHO","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500156857","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402091130","type":"NDC"}],"standard_charges":[{"gross_charge":27.34,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN RECOMBINANT 5000U TOP","drug_information":{"unit":"5000","type":"UN"},"code_information":[{"code":"2500156858","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338032201A","type":"NDC"}],"standard_charges":[{"gross_charge":395.91,"discounted_cash":158.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL HFA INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156860","type":"CDM"},{"code":"259","type":"RC"},{"code":"J3535","type":"HCPCS"},{"code":"69097014260A","type":"NDC"}],"standard_charges":[{"gross_charge":174.12,"discounted_cash":69.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"TRYPAN BLUE OPTH SOL","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2500156861","type":"CDM"},{"code":"250","type":"RC"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"gross_charge":208.83,"discounted_cash":83.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISCOAT 0.75ML SYRINGE","drug_information":{"unit":"0.75","type":"ML"},"code_information":[{"code":"2500156863","type":"CDM"},{"code":"250","type":"RC"},{"code":"08065183975","type":"NDC"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE 2.5MG T","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2500156864","type":"CDM"},{"code":"259","type":"RC"},{"code":"00555087202A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN PF 3 UNITS/3ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156867","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253044425A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE PCA","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"2500156869","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409263405A","type":"NDC"}],"standard_charges":[{"gross_charge":103.94,"discounted_cash":41.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL DSG PER 0.1MG UN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2500156870","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70004020240","type":"NDC"}],"standard_charges":[{"gross_charge":234.23,"discounted_cash":93.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM 2 GRAM/50ML IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500156871","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"25021061281A","type":"NDC"}],"standard_charges":[{"gross_charge":95.39,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 4% 5 GRAM CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156874","type":"CDM"},{"code":"250","type":"RC"},{"code":"00496088206","type":"NDC"}],"standard_charges":[{"gross_charge":46.99,"discounted_cash":18.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LEVOFLOXACIN 750MG T","drug_information":{"unit":"750","type":"ME"},"code_information":[{"code":"2500156875","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904635361A","type":"NDC"}],"standard_charges":[{"gross_charge":171.42,"discounted_cash":68.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLNALTREXONE 12MG/0.6ML I","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2500156877","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":658.07,"discounted_cash":263.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME 2 GRAM I","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500156878","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"00409973510A","type":"NDC"}],"standard_charges":[{"gross_charge":85.37,"discounted_cash":34.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINT W/EPI 2% I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500156882","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409014710A","type":"NDC"}],"standard_charges":[{"gross_charge":23.57,"discounted_cash":9.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE PF 1MG/ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156884","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0166","type":"HCPCS"},{"code":"54288010310A","type":"NDC"}],"standard_charges":[{"gross_charge":85.19,"discounted_cash":34.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 2% PF 5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156885","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409471302A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN/TAZOBACTAM 2.25G","drug_information":{"unit":"2.25","type":"GM"},"code_information":[{"code":"2500156886","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930A","type":"NDC"}],"standard_charges":[{"gross_charge":68.82,"discounted_cash":27.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 10MG/10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500156887","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041110A","type":"NDC"}],"standard_charges":[{"gross_charge":32.46,"discounted_cash":12.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CUPRIC CHLORIDE 4MG/10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500156890","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069050625A","type":"NDC"}],"standard_charges":[{"gross_charge":24.26,"discounted_cash":9.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONIVAPTAN 20MG PB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500156891","type":"CDM"},{"code":"250","type":"RC"},{"code":"66220016010A","type":"NDC"}],"standard_charges":[{"gross_charge":1478.28,"discounted_cash":591.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOD CHL 3% PF 15MI","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2500156894","type":"CDM"},{"code":"250","type":"RC"},{"code":"00378699789","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINO ACID 5%/DEX 20% 2000ML","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500156896","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338110104","type":"NDC"}],"standard_charges":[{"gross_charge":713.36,"discounted_cash":285.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINO ACID 5%/DEX 15% 2000ML","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500156897","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338109904","type":"NDC"}],"standard_charges":[{"gross_charge":713.36,"discounted_cash":285.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINO ACID 4.5%/DEX 10% 2000ML","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2500156898","type":"CDM"},{"code":"250","type":"RC"},{"code":"00338109104","type":"NDC"}],"standard_charges":[{"gross_charge":696.28,"discounted_cash":278.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500MG ADDVANTAGE","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500156900","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"00409014411","type":"NDC"}],"standard_charges":[{"gross_charge":46.8,"discounted_cash":18.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAROLINE 600MG INJ (TEFLARO","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2500156901","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"00456060010","type":"NDC"}],"standard_charges":[{"gross_charge":1033.7,"discounted_cash":413.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 10MG/ML INJ (OFI","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500156902","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781315695A","type":"NDC"}],"standard_charges":[{"gross_charge":228.33,"discounted_cash":91.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 10MG/ML INJ (OFI","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500156902","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781315695B","type":"NDC"}],"standard_charges":[{"gross_charge":228.33,"discounted_cash":91.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BECLOMETHASONE 80MCG INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156907","type":"CDM"},{"code":"259","type":"RC"},{"code":"59310030480A","type":"NDC"}],"standard_charges":[{"gross_charge":604.29,"discounted_cash":241.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"HYDROXYZINE 500MG/10ML INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500156909","type":"CDM"},{"code":"250","type":"RC"},{"code":"00517561025B","type":"NDC"}],"standard_charges":[{"gross_charge":39.36,"discounted_cash":15.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAROLINE 400MG INJ","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500156911","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"00456040010","type":"NDC"}],"standard_charges":[{"gross_charge":1017.65,"discounted_cash":407.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIDOFOVIR 375MG/5ML INJ","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2500156912","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155021631A","type":"NDC"}],"standard_charges":[{"gross_charge":1744.54,"discounted_cash":697.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CROMOLYN NA SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156913","type":"CDM"},{"code":"259","type":"RC"},{"code":"57782039726A","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ERIBULIN MESYLATE 1MG/2ML INJ","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500156914","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856038901","type":"NDC"}],"standard_charges":[{"gross_charge":2387.03,"discounted_cash":954.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 1% 10ML INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500156917","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150025110A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SOD INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2500156919","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323012310","type":"NDC"}],"standard_charges":[{"gross_charge":110.09,"discounted_cash":44.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEPAFENAC OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156920","type":"CDM"},{"code":"250","type":"RC"},{"code":"82667050003","type":"NDC"}],"standard_charges":[{"gross_charge":407.48,"discounted_cash":162.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"OMALIZUMAB 150MG INJ","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2500156921","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242004062","type":"NDC"}],"standard_charges":[{"gross_charge":1447.04,"discounted_cash":578.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGINTERFERON ALFA 2A INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156922","type":"CDM"},{"code":"250","type":"RC"},{"code":"82154044901A","type":"NDC"}],"standard_charges":[{"gross_charge":1173.0,"discounted_cash":469.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCOD 7.5 MG/ACETAMIN 325MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156923","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406052262A","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"DEXLANSOPRAZOLE 60MG CAP","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2500156924","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764017530A","type":"NDC"}],"standard_charges":[{"gross_charge":19.68,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE 10MG/PERPH 2MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156925","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378033001A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"ROFLUMILAST 500MCG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156932","type":"CDM"},{"code":"259","type":"RC"},{"code":"00310009530A","type":"NDC"}],"standard_charges":[{"gross_charge":32.45,"discounted_cash":12.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"KETOROLAC 15MG/ML INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156934","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075525A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CERTOLIZUMAB PEGOL 400MG","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500156935","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0717","type":"HCPCS"},{"code":"50474070062A","type":"NDC"}],"standard_charges":[{"gross_charge":25432.38,"discounted_cash":10172.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIKACIN 1000MG INJ","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2500156937","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"00641616610A","type":"NDC"}],"standard_charges":[{"gross_charge":91.51,"discounted_cash":36.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMOPHONE 1MG/ML VIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156938","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323085225A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CITALOPRAM HYDROBROM 10MG TAB","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500156940","type":"CDM"},{"code":"259","type":"RC"},{"code":"13668000901A","type":"NDC"}],"standard_charges":[{"gross_charge":16.1,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CERFEFOLIN 1 TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156941","type":"CDM"},{"code":"259","type":"RC"},{"code":"51991081190A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"FLUPHENAZINE 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500156942","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527179001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOSARTAN 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500156943","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084034801A","type":"NDC"}],"standard_charges":[{"gross_charge":14.62,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE 20MG CAP","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500156944","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378102005A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 400MG TAB","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500156945","type":"CDM"},{"code":"259","type":"RC"},{"code":"69452029030A","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CO-ENZYME Q13 30MG CAP","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2500156946","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536143607A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXOBAN 20MG TAB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500156947","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458057930A","type":"NDC"}],"standard_charges":[{"gross_charge":41.53,"discounted_cash":16.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 15MG TAB","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2500156948","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458057830A","type":"NDC"}],"standard_charges":[{"gross_charge":41.53,"discounted_cash":16.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITAZOXANIDE 500MG TAB","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500156949","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980052660A","type":"NDC"}],"standard_charges":[{"gross_charge":81.04,"discounted_cash":32.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELENIUM SULF 2.5%","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156950","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802004064A","type":"NDC"}],"standard_charges":[{"gross_charge":75.24,"discounted_cash":30.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 OZ"}]},{"description":"D5S + 40K 1000ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2500156951","type":"CDM"},{"code":"250","type":"RC"},{"code":"00990710909A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULF ER 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2500156954","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406839001","type":"NDC"}],"standard_charges":[{"gross_charge":23.31,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 1GM ADV","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2500156955","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00409258501A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROSPIUM 20MG TAB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2500156956","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462046160A","type":"NDC"}],"standard_charges":[{"gross_charge":20.12,"discounted_cash":8.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 200MCG INJ","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"2500156957","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288050503A","type":"NDC"}],"standard_charges":[{"gross_charge":270.48,"discounted_cash":108.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TINIDAZOLE 500MG TAB","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500156958","type":"CDM"},{"code":"259","type":"RC"},{"code":"42799020801A","type":"NDC"}],"standard_charges":[{"gross_charge":41.62,"discounted_cash":16.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TINIDAZOLE 500MG TAB","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2500156958","type":"CDM"},{"code":"259","type":"RC"},{"code":"42799020801B","type":"NDC"}],"standard_charges":[{"gross_charge":41.62,"discounted_cash":16.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXPAREL 1.3% 20ML INJ","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2500156959","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250026609A","type":"NDC"}],"standard_charges":[{"gross_charge":1686.51,"discounted_cash":674.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINAGLIPTIN 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2500156960","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597014030A","type":"NDC"}],"standard_charges":[{"gross_charge":40.49,"discounted_cash":16.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4% OIN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156961","type":"CDM"},{"code":"259","type":"RC"},{"code":"58914030180","type":"NDC"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":371.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"RUFINAMIDE 200MG TAB","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2500156962","type":"CDM"},{"code":"259","type":"RC"},{"code":"62856058252A","type":"NDC"}],"standard_charges":[{"gross_charge":72.15,"discounted_cash":28.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RUFINAMIDE 400MG TAB","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2500156963","type":"CDM"},{"code":"259","type":"RC"},{"code":"62856058352","type":"NDC"}],"standard_charges":[{"gross_charge":145.73,"discounted_cash":58.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 10MG INJ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2500156964","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781315972A","type":"NDC"}],"standard_charges":[{"gross_charge":196.97,"discounted_cash":78.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 100MCG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156965","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268085215A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"BENZOCAINE 20% MENTHOL 0.5%","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2500156966","type":"CDM"},{"code":"259","type":"RC"},{"code":"16864068002A","type":"NDC"}],"standard_charges":[{"gross_charge":27.44,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"LITHIUM CARB ER 450MG TAB","drug_information":{"unit":"450","type":"ME"},"code_information":[{"code":"2500156967","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054002025","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALANTAMINE ER 8MG CAP","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2500156969","type":"CDM"},{"code":"259","type":"RC"},{"code":"47335083583A","type":"NDC"}],"standard_charges":[{"gross_charge":30.19,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VILAZODONE 40MG TAB","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"250015696","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456114030A","type":"NDC"}],"standard_charges":[{"gross_charge":22.49,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tranexamic Acid 1,000mg/100mL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2500156970","type":"CDM"},{"code":"250","type":"RC"},{"code":"80830232902A","type":"NDC"}],"standard_charges":[{"gross_charge":105.82,"discounted_cash":42.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Morphine 50mg/50ml bag","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2500156971","type":"CDM"},{"code":"250","type":"RC"},{"code":"70092152235B","type":"NDC"}],"standard_charges":[{"gross_charge":86.1,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Meropenem 2g vial","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"2500156972","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567040206A","type":"NDC"}],"standard_charges":[{"gross_charge":169.96,"discounted_cash":67.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ampicillin Ped 30mg/ml syringe","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2500156973","type":"CDM"},{"code":"250","type":"RC"},{"code":"00781940495B","type":"NDC"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Gentamicin 800mg/20ml vial","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"2506332300","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020C","type":"NDC"}],"standard_charges":[{"gross_charge":163.89,"discounted_cash":65.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cn 100% Impaired - Ot Attention Current Status G-9165","code_information":[{"code":"2520297","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Attention Current Status G-9165","code_information":[{"code":"2520298","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Attention Current Status G-9165","code_information":[{"code":"2520299","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Attention Current Status G-9165","code_information":[{"code":"2520300","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Attention Current Status G-9165","code_information":[{"code":"2520301","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Attention Current Status G-9165","code_information":[{"code":"2520302","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Attention Current Status G-9165","code_information":[{"code":"2520303","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Attention Discharge Status G-9167","code_information":[{"code":"2520304","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Attention Discharge Status G-9167","code_information":[{"code":"2520305","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Attention Discharge Status G-9167","code_information":[{"code":"2520306","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CL|GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Attention Discharge Status G-9167","code_information":[{"code":"2520307","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Attention Discharge Status G-9167","code_information":[{"code":"2520308","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Attention Discharge Status G-9167","code_information":[{"code":"2520309","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Attention Discharge Status G-9167","code_information":[{"code":"2520310","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Attention Goal Status G-9166","code_information":[{"code":"2520311","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Attention Goal Status G-9166","code_information":[{"code":"2520312","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Attention Goal Status G-9166","code_information":[{"code":"2520313","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Attention Goal Status G-9166","code_information":[{"code":"2520314","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Attention Goal Status G-9166","code_information":[{"code":"2520315","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Attention Goal Status G-9166","code_information":[{"code":"2520316","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CI|GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ch 0% Impaired - Ot Attention Goal Status G-9166","code_information":[{"code":"2520317","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Body Position Current Status G-8981","code_information":[{"code":"2520318","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Body Position Current Status G-8981","code_information":[{"code":"2520319","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Body Position Current Status G-8981","code_information":[{"code":"2520320","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Body Position Current Status G-8981","code_information":[{"code":"2520321","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Body Position Current Status G-8981","code_information":[{"code":"2520322","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Body Position Current Status G-8981","code_information":[{"code":"2520323","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Body Position Current Status G-8981","code_information":[{"code":"2520324","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Body Position Dc Status G-8983","code_information":[{"code":"2520325","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Body Position Dc Status G-8983","code_information":[{"code":"2520326","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Body Position Dc Status G-8983","code_information":[{"code":"2520327","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Body Position Dc Status G-8983","code_information":[{"code":"2520328","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Body Position Dc Status G-8983","code_information":[{"code":"2520329","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Body Position Dc Status G-8983","code_information":[{"code":"2520330","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Body Position Dc Status G-8983","code_information":[{"code":"2520331","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Body Position Goal Status G-8982","code_information":[{"code":"2520332","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Body Position Goal Status G-8982","code_information":[{"code":"2520333","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Body Position Goal Status G-8982","code_information":[{"code":"2520334","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Body Position Goal Status G-8982","code_information":[{"code":"2520335","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Body Position Goal Status G-8982","code_information":[{"code":"2520336","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Body Position Goal Status G-8982","code_information":[{"code":"2520337","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Body Position Goal Status G-8982","code_information":[{"code":"2520338","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Carry Current Status  G-8984","code_information":[{"code":"2520339","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Carry Current Status  G-8984","code_information":[{"code":"2520340","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Carry Current Status  G-8984","code_information":[{"code":"2520341","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Carry Current Status  G-8984","code_information":[{"code":"2520342","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CK|GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Carry Current Status  G-8984","code_information":[{"code":"2520343","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Carry Current Status  G-8984","code_information":[{"code":"2520344","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Carry Current Status  G-8984","code_information":[{"code":"2520345","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Carry Discharge Status G-8986","code_information":[{"code":"2520346","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Carry Discharge Status G-8986","code_information":[{"code":"2520347","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Carry Discharge Status G-8986","code_information":[{"code":"2520348","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Carry Discharge Status G-8986","code_information":[{"code":"2520349","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Carry Discharge Status G-8986","code_information":[{"code":"2520350","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Carry Discharge Status G-8986","code_information":[{"code":"2520351","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Carry Discharge Status G-8986","code_information":[{"code":"2520352","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Carry Goal Status G-8985","code_information":[{"code":"2520353","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Carry Goal Status G-8985","code_information":[{"code":"2520354","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Carry Goal Status G-8985","code_information":[{"code":"2520355","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Carry Goal Status G-8985","code_information":[{"code":"2520356","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Carry Goal Status G-8985","code_information":[{"code":"2520357","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Carry Goal Status G-8985","code_information":[{"code":"2520358","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Carry Goal Status G-8985","code_information":[{"code":"2520359","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Memory Current Status G-9168","code_information":[{"code":"2520360","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Memory Current Status G-9168","code_information":[{"code":"2520361","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Memory Current Status G-9168","code_information":[{"code":"2520362","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Memory Current Status G-9168","code_information":[{"code":"2520363","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Memory Current Status G-9168","code_information":[{"code":"2520364","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Memory Current Status G-9168","code_information":[{"code":"2520365","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Memory Current Status G-9168","code_information":[{"code":"2520366","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Memory Discharge Status G-9170","code_information":[{"code":"2520367","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Memory Discharge Status G-9170","code_information":[{"code":"2520368","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Memory Discharge Status G-9170","code_information":[{"code":"2520369","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Memory Discharge Status G-9170","code_information":[{"code":"2520370","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Memory Discharge Status G-9170","code_information":[{"code":"2520371","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Memory Discharge Status G-9170","code_information":[{"code":"2520372","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Memory Discharge Status G-9170","code_information":[{"code":"2520373","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Memory Goal Status G-9169","code_information":[{"code":"2520374","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Memory Goal Status G-9169","code_information":[{"code":"2520375","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Memory Goal Status G-9169","code_information":[{"code":"2520376","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Memory Goal Status G-9169","code_information":[{"code":"2520377","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Memory Goal Status G-9169","code_information":[{"code":"2520378","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Memory Goal Status G-9169","code_information":[{"code":"2520379","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Memory Goal Status G-9169","code_information":[{"code":"2520380","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Mobility Current Status G-8978","code_information":[{"code":"2520381","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Mobility Current Status G-8978","code_information":[{"code":"2520382","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Mobility Current Status G-8978","code_information":[{"code":"2520383","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Mobility Current Status G-8978","code_information":[{"code":"2520384","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Mobility Current Status G-8978","code_information":[{"code":"2520385","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Mobility Current Status G-8978","code_information":[{"code":"2520386","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ch 0% Impaired - Ot Mobility Current Status G-8978","code_information":[{"code":"2520387","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cn 100% Impaired - Ot Mobility Discharge Status G-8980","code_information":[{"code":"2520388","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Mobility Discharge Status G-8980","code_information":[{"code":"2520389","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Mobility Discharge Status G-8980","code_information":[{"code":"2520390","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Mobility Discharge Status G-8980","code_information":[{"code":"2520391","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Mobility Discharge Status G-8980","code_information":[{"code":"2520392","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Mobility Discharge Status G-8980","code_information":[{"code":"2520393","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Mobility Discharge Status G-8980","code_information":[{"code":"2520394","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cn 100% Impaired - Ot Mobility Goal Status G-8979","code_information":[{"code":"2520395","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Mobility Goal Status G-8979","code_information":[{"code":"2520396","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Mobility Goal Status G-8979","code_information":[{"code":"2520397","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Mobility Goal Status G-8979","code_information":[{"code":"2520398","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Mobility Goal Status G-8979","code_information":[{"code":"2520399","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Mobility Goal Status G-8979","code_information":[{"code":"2520400","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ch 0% Impaired - Ot Mobility Goal Status G-8979","code_information":[{"code":"2520401","type":"CDM"},{"code":"430","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cn 100% Impaired - Ot Other Primary Current Status G-8990","code_information":[{"code":"2520402","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Other Primary Current Status G-8990","code_information":[{"code":"2520403","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Other Primary Current Status G-8990","code_information":[{"code":"2520404","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Other Primary Current Status G-8990","code_information":[{"code":"2520405","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Other Primary Current Status G-8990","code_information":[{"code":"2520406","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Other Primary Current Status G-8990","code_information":[{"code":"2520407","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Other Primary Current Status G-8990","code_information":[{"code":"2520408","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Other Primary Discharge Status G-8992","code_information":[{"code":"2520409","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Other Primary Discharge Status G-8992","code_information":[{"code":"2520410","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Other Primary Discharge Status G-8992","code_information":[{"code":"2520411","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Other Primary Discharge Status G-8992","code_information":[{"code":"2520412","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Other Primary Discharge Status G-8992","code_information":[{"code":"2520413","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CJ|GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Other Primary Discharge Status G-8992","code_information":[{"code":"2520414","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Other Primary Discharge Status G-8992","code_information":[{"code":"2520415","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Other Primary Goal Status G-8991","code_information":[{"code":"2520416","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Other Primary Goal Status G-8991","code_information":[{"code":"2520417","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Other Primary Goal Status G-8991","code_information":[{"code":"2520418","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Other Primary Goal Status G-8991","code_information":[{"code":"2520419","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Other Primary Goal Status G-8991","code_information":[{"code":"2520420","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Other Primary Goal Status G-8991","code_information":[{"code":"2520421","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Other Primary Goal Status G-8991","code_information":[{"code":"2520422","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Self-Care Current Status G-8987","code_information":[{"code":"2520423","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Self-Care Current Status G-8987","code_information":[{"code":"2520424","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Self-Care Current Status G-8987","code_information":[{"code":"2520425","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Self-Care Current Status G-8987","code_information":[{"code":"2520426","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Self-Care Current Status G-8987","code_information":[{"code":"2520427","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Self-Care Current Status G-8987","code_information":[{"code":"2520428","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Self-Care Current Status G-8987","code_information":[{"code":"2520429","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Self-Care Discharge Status G-8989","code_information":[{"code":"2520430","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Self-Care Discharge Status G-8989","code_information":[{"code":"2520431","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Self-Care Discharge Status G-8989","code_information":[{"code":"2520432","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Self-Care Discharge Status G-8989","code_information":[{"code":"2520433","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Self-Care Discharge Status G-8989","code_information":[{"code":"2520434","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Self-Care Discharge Status G-8989","code_information":[{"code":"2520435","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Self-Care Discharge Status G-8989","code_information":[{"code":"2520436","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Self-Care Goal Status G-8988","code_information":[{"code":"2520437","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Self-Care Goal Status G-8988","code_information":[{"code":"2520438","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Self-Care Goal Status G-8988","code_information":[{"code":"2520439","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Self-Care Goal Status G-8988","code_information":[{"code":"2520440","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Self-Care Goal Status G-8988","code_information":[{"code":"2520441","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Self-Care Goal Status G-8988","code_information":[{"code":"2520442","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Self-Care Goal Status G-8988","code_information":[{"code":"2520443","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Subsequent Current Status G-8993","code_information":[{"code":"2520444","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Subsequent Current Status G-8993","code_information":[{"code":"2520445","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Subsequent Current Status G-8993","code_information":[{"code":"2520446","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Subsequent Current Status G-8993","code_information":[{"code":"2520447","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Subsequent Current Status G-8993","code_information":[{"code":"2520448","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Subsequent Current Status G-8993","code_information":[{"code":"2520449","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Subsequent Current Status G-8993","code_information":[{"code":"2520450","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Subsequent Discharge Status G-8995","code_information":[{"code":"2520451","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Subsequent Discharge Status G-8995","code_information":[{"code":"2520452","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Subsequent Discharge Status G-8995","code_information":[{"code":"2520453","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Subsequent Discharge Status G-8995","code_information":[{"code":"2520454","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Subsequent Discharge Status G-8995","code_information":[{"code":"2520455","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Subsequent Discharge Status G-8995","code_information":[{"code":"2520456","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Subsequent Discharge Status G-8995","code_information":[{"code":"2520457","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Ot Subsequent Goal Status G-8994","code_information":[{"code":"2520458","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Ot Subsequent Goal Status G-8994","code_information":[{"code":"2520459","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CM|GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Ot Subsequent Goal Status G-8994","code_information":[{"code":"2520460","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Ot Subsequent Goal Status G-8994","code_information":[{"code":"2520461","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Ot Subsequent Goal Status G-8994","code_information":[{"code":"2520462","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Ot Subsequent Goal Status G-8994","code_information":[{"code":"2520463","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Ot Subsequent Goal Status G-8994","code_information":[{"code":"2520464","type":"CDM"},{"code":"434","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GO|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Body Position Dc Status G-8983","code_information":[{"code":"2520465","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Body Position Dc Status G-8983","code_information":[{"code":"2520466","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Body Position Dc Status G-8983","code_information":[{"code":"2520467","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Body Position Dc Status G-8983","code_information":[{"code":"2520468","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Body Position Dc Status G-8983","code_information":[{"code":"2520469","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Body Position Dc Status G-8983","code_information":[{"code":"2520470","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Body Position Dc Status G-8983","code_information":[{"code":"2520471","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Body Position Goal Status G-8982","code_information":[{"code":"2520472","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Body Position Goal Status G-8982","code_information":[{"code":"2520473","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Body Position Goal Status G-8982","code_information":[{"code":"2520474","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Body Position Goal Status G-8982","code_information":[{"code":"2520475","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Body Position Goal Status G-8982","code_information":[{"code":"2520476","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Body Position Goal Status G-8982","code_information":[{"code":"2520477","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Body Position Goal Status G-8982","code_information":[{"code":"2520478","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Carry Current Status G-8984","code_information":[{"code":"2520479","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Carry Current Status G-8984","code_information":[{"code":"2520480","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Carry Current Status G-8984","code_information":[{"code":"2520481","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Carry Current Status G-8984","code_information":[{"code":"2520482","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Carry Current Status G-8984","code_information":[{"code":"2520483","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Carry Current Status G-8984","code_information":[{"code":"2520484","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Carry Current Status G-8984","code_information":[{"code":"2520485","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Carry Discharge Status G-8986","code_information":[{"code":"2520486","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Carry Discharge Status G-8986","code_information":[{"code":"2520487","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Carry Discharge Status G-8986","code_information":[{"code":"2520488","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Carry Discharge Status G-8986","code_information":[{"code":"2520489","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Carry Discharge Status G-8986","code_information":[{"code":"2520490","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Carry Discharge Status G-8986","code_information":[{"code":"2520491","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Carry Discharge Status G-8986","code_information":[{"code":"2520492","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Carry Goal Status G-8985","code_information":[{"code":"2520493","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Carry Goal Status G-8985","code_information":[{"code":"2520494","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Carry Goal Status G-8985","code_information":[{"code":"2520495","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Carry Goal Status G-8985","code_information":[{"code":"2520496","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Carry Goal Status G-8985","code_information":[{"code":"2520497","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Carry Goal Status G-8985","code_information":[{"code":"2520498","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Carry Goal Status G-8985","code_information":[{"code":"2520499","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Mobility Discharge Status G-8980","code_information":[{"code":"2520500","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Mobility Discharge Status G-8980","code_information":[{"code":"2520501","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Mobility Discharge Status G-8980","code_information":[{"code":"2520502","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Mobility Discharge Status G-8980","code_information":[{"code":"2520503","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Mobility Discharge Status G-8980","code_information":[{"code":"2520504","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Mobility Discharge Status G-8980","code_information":[{"code":"2520505","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Mobility Discharge Status G-8980","code_information":[{"code":"2520506","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cn 100% Impaired - Pt Self-Care Current Status G-8987","code_information":[{"code":"2520507","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Self-Care Current Status G-8987","code_information":[{"code":"2520508","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Self-Care Current Status G-8987","code_information":[{"code":"2520509","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Self-Care Current Status G-8987","code_information":[{"code":"2520510","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Self-Care Current Status G-8987","code_information":[{"code":"2520511","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Self-Care Current Status G-8987","code_information":[{"code":"2520512","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Self-Care Current Status G-8987","code_information":[{"code":"2520513","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Self-Care Discharge Status G-8989","code_information":[{"code":"2520514","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Self-Care Discharge Status G-8989","code_information":[{"code":"2520515","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Self-Care Discharge Status G-8989","code_information":[{"code":"2520516","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Self-Care Discharge Status G-8989","code_information":[{"code":"2520517","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Self-Care Discharge Status G-8989","code_information":[{"code":"2520518","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Self-Care Discharge Status G-8989","code_information":[{"code":"2520519","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Self-Care Discharge Status G-8989","code_information":[{"code":"2520520","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Self-Care Goal Status G-8988","code_information":[{"code":"2520521","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Self-Care Goal Status G-8988","code_information":[{"code":"2520522","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Self-Care Goal Status G-8988","code_information":[{"code":"2520523","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Self-Care Goal Status G-8988","code_information":[{"code":"2520524","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Self-Care Goal Status G-8988","code_information":[{"code":"2520525","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Self-Care Goal Status G-8988","code_information":[{"code":"2520526","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Self-Care Goal Status G-8988","code_information":[{"code":"2520527","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Mobility Current Status G-8978","code_information":[{"code":"2520528","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Mobility Current Status G-8978","code_information":[{"code":"2520529","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Mobility Current Status G-8978","code_information":[{"code":"2520530","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Mobility Current Status G-8978","code_information":[{"code":"2520531","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Mobility Current Status G-8978","code_information":[{"code":"2520532","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Mobility Current Status G-8978","code_information":[{"code":"2520533","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ch 0% Impaired - Pt Mobility Current Status G-8978","code_information":[{"code":"2520534","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cn 100% Impaired - Pt Mobility Goal Status G-8979","code_information":[{"code":"2520535","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Mobility Goal Status G-8979","code_information":[{"code":"2520536","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Mobility Goal Status G-8979","code_information":[{"code":"2520537","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Mobility Goal Status G-8979","code_information":[{"code":"2520538","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Mobility Goal Status G-8979","code_information":[{"code":"2520539","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Mobility Goal Status G-8979","code_information":[{"code":"2520540","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ch 0% Impaired - Pt Mobility Goal Status G-8979","code_information":[{"code":"2520541","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cn 100% Impaired - Motor Speech Current Status G-8999","code_information":[{"code":"2520543","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Motor Speech Current Status G-8999","code_information":[{"code":"2520544","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Motor Speech Current Status G-8999","code_information":[{"code":"2520545","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Motor Speech Current Status G-8999","code_information":[{"code":"2520546","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Motor Speech Current Status G-8999","code_information":[{"code":"2520547","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Motor Speech Current Status G-8999","code_information":[{"code":"2520548","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Motor Speech Current Status G-8999","code_information":[{"code":"2520549","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Other Primary Discharge Status G-8992","code_information":[{"code":"2520550","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Other Primary Discharge Status G-8992","code_information":[{"code":"2520551","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Other Primary Discharge Status G-8992","code_information":[{"code":"2520552","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Other Primary Discharge Status G-8992","code_information":[{"code":"2520553","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Other Primary Discharge Status G-8992","code_information":[{"code":"2520554","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Other Primary Discharge Status G-8992","code_information":[{"code":"2520555","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Other Primary Discharge Status G-8992","code_information":[{"code":"2520556","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Other Primary Goal Status G-8991","code_information":[{"code":"2520557","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Other Primary Goal Status G-8991","code_information":[{"code":"2520558","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Other Primary Goal Status G-8991","code_information":[{"code":"2520559","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Other Primary Goal Status G-8991","code_information":[{"code":"2520560","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Other Primary Goal Status G-8991","code_information":[{"code":"2520561","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Other Primary Goal Status G-8991","code_information":[{"code":"2520562","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Other Primary Goal Status G-8991","code_information":[{"code":"2520563","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Subsequent Current Status G-8993","code_information":[{"code":"2520564","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Subsequent Current Status G-8993","code_information":[{"code":"2520565","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Subsequent Current Status G-8993","code_information":[{"code":"2520566","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Subsequent Current Status G-8993","code_information":[{"code":"2520567","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Subsequent Current Status G-8993","code_information":[{"code":"2520568","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Subsequent Current Status G-8993","code_information":[{"code":"2520569","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Subsequent Current Status G-8993","code_information":[{"code":"2520570","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Subsequent Dc Status G-8995","code_information":[{"code":"2520571","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Subsequent Dc Status G-8995","code_information":[{"code":"2520572","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CM|GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Subsequent Dc Status G-8995","code_information":[{"code":"2520573","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Subsequent Dc Status G-8995","code_information":[{"code":"2520574","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Subsequent Dc Status G-8995","code_information":[{"code":"2520575","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CJ|GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Subsequent Dc Status G-8995","code_information":[{"code":"2520576","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Subsequent Dc Status G-8995","code_information":[{"code":"2520577","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Subsequent Goal Status G-8994","code_information":[{"code":"2520578","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Subsequent Goal Status G-8994","code_information":[{"code":"2520579","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Subsequent Goal Status G-8994","code_information":[{"code":"2520580","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Subsequent Goal Status G-8994","code_information":[{"code":"2520581","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Subsequent Goal Status G-8994","code_information":[{"code":"2520582","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CJ|GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Subsequent Goal Status G-8994","code_information":[{"code":"2520583","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Subsequent Goal Status G-8994","code_information":[{"code":"2520584","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Swallow Current Status G-8996","code_information":[{"code":"2520585","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Swallow Current Status G-8996","code_information":[{"code":"2520586","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Swallow Current Status G-8996","code_information":[{"code":"2520587","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Swallow Current Status G-8996","code_information":[{"code":"2520588","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Swallow Current Status G-8996","code_information":[{"code":"2520589","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Swallow Current Status G-8996","code_information":[{"code":"2520590","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Swallow Current Status G-8996","code_information":[{"code":"2520591","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Swallow Discharge Status G-8998","code_information":[{"code":"2520592","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Swallow Discharge Status G-8998","code_information":[{"code":"2520593","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Swallow Discharge Status G-8998","code_information":[{"code":"2520594","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Swallow Discharge Status G-8998","code_information":[{"code":"2520595","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Swallow Discharge Status G-8998","code_information":[{"code":"2520596","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Swallow Discharge Status G-8998","code_information":[{"code":"2520597","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Swallow Discharge Status G-8998","code_information":[{"code":"2520598","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Swallow Goal Status G-8997","code_information":[{"code":"2520599","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Swallow Goal Status G-8997","code_information":[{"code":"2520600","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Swallow Goal Status G-8997","code_information":[{"code":"2520601","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Swallow Goal Status G-8997","code_information":[{"code":"2520602","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Swallow Goal Status G-8997","code_information":[{"code":"2520603","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Swallow Goal Status G-8997","code_information":[{"code":"2520604","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Swallow Goal Status G-8997","code_information":[{"code":"2520605","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Attention Current Status G-9165","code_information":[{"code":"2520606","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Attention Current Status G-9165","code_information":[{"code":"2520607","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Attention Current Status G-9165","code_information":[{"code":"2520608","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Attention Current Status G-9165","code_information":[{"code":"2520609","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Attention Current Status G-9165","code_information":[{"code":"2520610","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Attention Current Status G-9165","code_information":[{"code":"2520611","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Attention Current Status G-9165","code_information":[{"code":"2520612","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Attention Discharge Status G-9167","code_information":[{"code":"2520613","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CN|GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CN: 100 percent impaired, limited or restricted | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Attention Discharge Status G-9167","code_information":[{"code":"2520614","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Attention Discharge Status G-9167","code_information":[{"code":"2520615","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Attention Discharge Status G-9167","code_information":[{"code":"2520616","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Attention Discharge Status G-9167","code_information":[{"code":"2520617","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Attention Discharge Status G-9167","code_information":[{"code":"2520618","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Attention Discharge Status G-9167","code_information":[{"code":"2520619","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Attention Goal Status G-9166","code_information":[{"code":"2520620","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Attention Goal Status G-9166","code_information":[{"code":"2520621","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Attention Goal Status G-9166","code_information":[{"code":"2520622","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Attention Goal Status G-9166","code_information":[{"code":"2520623","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Attention Goal Status G-9166","code_information":[{"code":"2520624","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Attention Goal Status G-9166","code_information":[{"code":"2520625","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Attention Goal Status G-9166","code_information":[{"code":"2520626","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Memory Current Status G-9168","code_information":[{"code":"2520627","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Memory Current Status G-9168","code_information":[{"code":"2520628","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Memory Current Status G-9168","code_information":[{"code":"2520629","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Memory Current Status G-9168","code_information":[{"code":"2520630","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Memory Current Status G-9168","code_information":[{"code":"2520631","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Memory Current Status G-9168","code_information":[{"code":"2520632","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Memory Current Status G-9168","code_information":[{"code":"2520633","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Memory Discharge Status G-9170","code_information":[{"code":"2520634","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Memory Discharge Status G-9170","code_information":[{"code":"2520635","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Memory Discharge Status G-9170","code_information":[{"code":"2520636","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Memory Discharge Status G-9170","code_information":[{"code":"2520637","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Memory Discharge Status G-9170","code_information":[{"code":"2520638","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Memory Discharge Status G-9170","code_information":[{"code":"2520639","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Memory Discharge Status G-9170","code_information":[{"code":"2520640","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Memory Goal Status G-9169","code_information":[{"code":"2520641","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Memory Goal Status G-9169","code_information":[{"code":"2520642","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CM|GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Memory Goal Status G-9169","code_information":[{"code":"2520643","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Memory Goal Status G-9169","code_information":[{"code":"2520644","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Memory Goal Status G-9169","code_information":[{"code":"2520645","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Memory Goal Status G-9169","code_information":[{"code":"2520646","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Memory Goal Status G-9169","code_information":[{"code":"2520647","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Motor Speech Discharge Status G-9158","code_information":[{"code":"2520648","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Motor Speech Discharge Status G-9158","code_information":[{"code":"2520649","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Motor Speech Discharge Status G-9158","code_information":[{"code":"2520650","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Motor Speech Discharge Status G-9158","code_information":[{"code":"2520651","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Motor Speech Discharge Status G-9158","code_information":[{"code":"2520652","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Motor Speech Discharge Status G-9158","code_information":[{"code":"2520653","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Motor Speech Discharge Status G-9158","code_information":[{"code":"2520654","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Motor Speech Goal Status G-9186","code_information":[{"code":"2520655","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Motor Speech Goal Status G-9186","code_information":[{"code":"2520656","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Motor Speech Goal Status G-9186","code_information":[{"code":"2520657","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Motor Speech Goal Status G-9186","code_information":[{"code":"2520658","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Motor Speech Goal Status G-9186","code_information":[{"code":"2520659","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Motor Speech Goal Status G-9186","code_information":[{"code":"2520660","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Motor Speech Goal Status G-9186","code_information":[{"code":"2520661","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Other Slp Discharge Status G-9176","code_information":[{"code":"2520662","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Other Slp Discharge Status G-9176","code_information":[{"code":"2520663","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Other Slp Discharge Status G-9176","code_information":[{"code":"2520664","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Other Slp Discharge Status G-9176","code_information":[{"code":"2520665","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Other Slp Discharge Status G-9176","code_information":[{"code":"2520666","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Other Slp Discharge Status G-9176","code_information":[{"code":"2520667","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Other Slp Discharge Status G-9176","code_information":[{"code":"2520668","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Other Slp Goal Status G-9175","code_information":[{"code":"2520669","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Other Slp Goal Status G-9175","code_information":[{"code":"2520670","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Other Slp Goal Status G-9175","code_information":[{"code":"2520671","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Other Slp Goal Status G-9175","code_information":[{"code":"2520672","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Other Slp Goal Status G-9175","code_information":[{"code":"2520673","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Other Slp Goal Status G-9175","code_information":[{"code":"2520674","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Other Slp Goal Status G-9175","code_information":[{"code":"2520675","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Spoken Lang Comprehension Current G-9159","code_information":[{"code":"2520676","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Spoken Lang Comprehension Current G-9159","code_information":[{"code":"2520677","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Spoken Lang Comprehension Current G-9159","code_information":[{"code":"2520678","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Spoken Lang Comprehension Current G-9159","code_information":[{"code":"2520679","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Spoken Lang Comprehension Current G-9159","code_information":[{"code":"2520680","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Spoken Lang Comprehension Current G-9159","code_information":[{"code":"2520681","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CI|GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Ch 0% Impaired - Spoken Lang Comprehension Current G-9159","code_information":[{"code":"2520682","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Spoken Lang Comprehension Dc G-9161","code_information":[{"code":"2520683","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Spoken Lang Comprehension Dc G-9161","code_information":[{"code":"2520684","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Spoken Lang Comprehension Dc G-9161","code_information":[{"code":"2520685","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Spoken Lang Comprehension Dc G-9161","code_information":[{"code":"2520686","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Spoken Lang Comprehension Dc G-9161","code_information":[{"code":"2520687","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Spoken Lang Comprehension Dc G-9161","code_information":[{"code":"2520688","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Spoken Lang Comprehension Dc G-9161","code_information":[{"code":"2520689","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Spoken Lang Comprehension Goal G-9160","code_information":[{"code":"2520690","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Spoken Lang Comprehension Goal G-9160","code_information":[{"code":"2520691","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Spoken Lang Comprehension Goal G-9160","code_information":[{"code":"2520692","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Spoken Lang Comprehension Goal G-9160","code_information":[{"code":"2520693","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Spoken Lang Comprehension Goal G-9160","code_information":[{"code":"2520694","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Spoken Lang Comprehension Goal G-9160","code_information":[{"code":"2520695","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Spoken Lang Comprehension Goal G-9160","code_information":[{"code":"2520696","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Spoken Lang Expression Current G-9162","code_information":[{"code":"2520697","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"CN|GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier CN: 100 percent impaired, limited or restricted | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Spoken Lang Expression Current G-9162","code_information":[{"code":"2520698","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Spoken Lang Expression Current G-9162","code_information":[{"code":"2520699","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Spoken Lang Expression Current G-9162","code_information":[{"code":"2520700","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Spoken Lang Expression Current G-9162","code_information":[{"code":"2520701","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Spoken Lang Expression Current G-9162","code_information":[{"code":"2520702","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Spoken Lang Expression Current G-9162","code_information":[{"code":"2520703","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Spoken Lang Expression Dc Status G-9164","code_information":[{"code":"2520704","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Spoken Lang Expression Dc Status G-9164","code_information":[{"code":"2520705","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Spoken Lang Expression Dc Status G-9164","code_information":[{"code":"2520706","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Spoken Lang Expression Dc Status G-9164","code_information":[{"code":"2520707","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Spoken Lang Expression Dc Status G-9164","code_information":[{"code":"2520708","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Spoken Lang Expression Dc Status G-9164","code_information":[{"code":"2520709","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Spoken Lang Expression Dc Status G-9164","code_information":[{"code":"2520710","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Spoken Language Expression Goal G-9163","code_information":[{"code":"2520711","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Spoken Language Expression Goal G-9163","code_information":[{"code":"2520712","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Spoken Language Expression Goal G-9163","code_information":[{"code":"2520713","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Spoken Language Expression Goal G-9163","code_information":[{"code":"2520714","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Spoken Language Expression Goal G-9163","code_information":[{"code":"2520715","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Spoken Language Expression Goal G-9163","code_information":[{"code":"2520716","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Spoken Language Expression Goal G-9163","code_information":[{"code":"2520717","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Voice Current Status G-9171","code_information":[{"code":"2520718","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Voice Current Status G-9171","code_information":[{"code":"2520719","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Voice Current Status G-9171","code_information":[{"code":"2520720","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Voice Current Status G-9171","code_information":[{"code":"2520721","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Voice Current Status G-9171","code_information":[{"code":"2520722","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Voice Current Status G-9171","code_information":[{"code":"2520723","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Voice Current Status G-9171","code_information":[{"code":"2520724","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Voice Discharge Status G-9173","code_information":[{"code":"2520725","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Voice Discharge Status G-9173","code_information":[{"code":"2520726","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Voice Discharge Status G-9173","code_information":[{"code":"2520727","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Voice Discharge Status G-9173","code_information":[{"code":"2520728","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Voice Discharge Status G-9173","code_information":[{"code":"2520729","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Voice Discharge Status G-9173","code_information":[{"code":"2520730","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Voice Discharge Status G-9173","code_information":[{"code":"2520731","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Voice Goal Status G-9172","code_information":[{"code":"2520732","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Voice Goal Status G-9172","code_information":[{"code":"2520733","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Voice Goal Status G-9172","code_information":[{"code":"2520734","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Voice Goal Status G-9172","code_information":[{"code":"2520735","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Voice Goal Status G-9172","code_information":[{"code":"2520736","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Voice Goal Status G-9172","code_information":[{"code":"2520737","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Voice Goal Status G-9172","code_information":[{"code":"2520738","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Other Primary Current Status G-8990","code_information":[{"code":"2520739","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Other Primary Current Status G-8990","code_information":[{"code":"2520740","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Other Primary Current Status G-8990","code_information":[{"code":"2520741","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Other Primary Current Status G-8990","code_information":[{"code":"2520742","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Other Primary Current Status G-8990","code_information":[{"code":"2520743","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Other Primary Current Status G-8990","code_information":[{"code":"2520744","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Other Primary Current Status G-8990","code_information":[{"code":"2520745","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Pt Body Position Current Status G-8981","code_information":[{"code":"2520746","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Pt Body Position Current Status G-8981","code_information":[{"code":"2520747","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Pt Body Position Current Status G-8981","code_information":[{"code":"2520748","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Pt Body Position Current Status G-8981","code_information":[{"code":"2520749","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Pt Body Position Current Status G-8981","code_information":[{"code":"2520750","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Pt Body Position Current Status G-8981","code_information":[{"code":"2520751","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Pt Body Position Current Status G-8981","code_information":[{"code":"2520752","type":"CDM"},{"code":"424","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GP|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"Cn 100% Impaired - Other Slp Current Status G-9174","code_information":[{"code":"2520753","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CN: 100 percent impaired, limited or restricted"}]},{"description":"Cm At Least 80% But Less Than 100% Impaired - Other Slp Current Status G-9174","code_information":[{"code":"2520754","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CM","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted"}]},{"description":"Cl At Least 60% But Less Than 80% Impaired - Other Slp Current Status G-9174","code_information":[{"code":"2520755","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CL","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted"}]},{"description":"Ck At Least 40% But Less Than 60% Impaired - Other Slp Current Status G-9174","code_information":[{"code":"2520756","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CK","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted"}]},{"description":"Cj At Least 20% But Less Than 40% Impaired - Other Slp Current Status G-9174","code_information":[{"code":"2520757","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CJ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted"}]},{"description":"Ci At Least 1% But Less Than 20% Impaired - Other Slp Current Status G-9174","code_information":[{"code":"2520758","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted"}]},{"description":"Ch 0% Impaired - Other Slp Current Status G-9174","code_information":[{"code":"2520759","type":"CDM"},{"code":"444","type":"RC"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","modifiers":"GN|CH","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care | Modifier CH: 0 percent impaired, limited or restricted"}]},{"description":"INJ VINORELBINE PER 10MG/50","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2580000001","type":"CDM"},{"code":"636","type":"RC"},{"code":"25021020405A","type":"NDC"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE .45% 100ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2580000003","type":"CDM"},{"code":"258","type":"RC"},{"code":"63323062600A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN 400MG PB","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2580000004","type":"CDM"},{"code":"258","type":"RC"},{"code":"50419053701A","type":"NDC"}],"standard_charges":[{"gross_charge":160.91,"discounted_cash":64.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTRAN 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2580000006","type":"CDM"},{"code":"258","type":"RC"},{"code":"00409741903","type":"NDC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"1/2S20K IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2580000007","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990925739A","type":"NDC"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":37.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM 40 GM/1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2580000008","type":"CDM"},{"code":"258","type":"RC"},{"code":"63323010610A","type":"NDC"}],"standard_charges":[{"gross_charge":48.7,"discounted_cash":19.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5W + 20 KCL 1000ML BAG","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2580000011","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338068304","type":"NDC"}],"standard_charges":[{"gross_charge":98.86,"discounted_cash":39.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXT 5% 100ML ADV","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2580000012","type":"CDM"},{"code":"258","type":"RC"},{"code":"00409710067","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXT 5% 100ML MINI","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2580000013","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338055118","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALINE 100ML MINI","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"2580000015","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338055318","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALINE 50ML MINI","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2580000016","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338055311","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORMAL SALINE 0.9% 150ML I","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"2580000018","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990798361A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORMAL SALINE 0.9% 250ML ADDVI","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"2580000019","type":"CDM"},{"code":"258","type":"RC"},{"code":"00409710102","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5LR+OXYTOCIN 20 UN 1000ML IV","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"2580000024","type":"CDM"},{"code":"258","type":"RC"},{"code":"70004008246","type":"NDC"}],"standard_charges":[{"gross_charge":189.85,"discounted_cash":75.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOSYN 15% 2000ML IV","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2580000026","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990717117A","type":"NDC"}],"standard_charges":[{"gross_charge":229.15,"discounted_cash":91.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 20% 500ML IV","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2580000027","type":"CDM"},{"code":"258","type":"RC"},{"code":"00990793519A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 40MG/40ML VIAL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"2580000028","type":"CDM"},{"code":"259","type":"RC"},{"code":"S0028","type":"HCPCS"},{"code":"63323073804A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN 50 000 UNIT/10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2580000030","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323004710A","type":"NDC"}],"standard_charges":[{"gross_charge":72.93,"discounted_cash":29.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOZAPINE 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590000039","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687041501A","type":"NDC"}],"standard_charges":[{"gross_charge":9.91,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IVERMECTIN 3MG TAB","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2590000040","type":"CDM"},{"code":"259","type":"RC"},{"code":"00006003220A","type":"NDC"}],"standard_charges":[{"gross_charge":22.07,"discounted_cash":8.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UREA/ALPHA HYDROXY ACIDS TUBE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000041","type":"CDM"},{"code":"259","type":"RC"},{"code":"11701002214A","type":"NDC"}],"standard_charges":[{"gross_charge":55.58,"discounted_cash":22.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"Morphine 30mg IR tab","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2590000054","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054023625A","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINACLOTIDE 72 MCG CAP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000070","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456120330B","type":"NDC"}],"standard_charges":[{"gross_charge":67.06,"discounted_cash":26.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 72 MCG"}]},{"description":"TENOFOVIR DISO FUMA 300MG TAB","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2590000071","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862042130A","type":"NDC"}],"standard_charges":[{"gross_charge":184.07,"discounted_cash":73.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRINZOLAMIDE/BRIMONIDINE O/S B","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000080","type":"CDM"},{"code":"259","type":"RC"},{"code":"00065414727B","type":"NDC"}],"standard_charges":[{"gross_charge":774.45,"discounted_cash":309.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"DICYCLOMINE 20MG TAB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590000082","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687038001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN D 2000U TAB","drug_information":{"unit":"2000","type":"UN"},"code_information":[{"code":"2590000083","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268086515A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAMOXINE/ZINC CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000084","type":"CDM"},{"code":"259","type":"RC"},{"code":"11868081401A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CALCIUM/VIT D 600MG-400U TAB","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2590000085","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268015015A","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL ACETATE 40MG TAB","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590000086","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904723661A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELOXICAM 15MG TAB","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2590000087","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268052615A","type":"NDC"}],"standard_charges":[{"gross_charge":22.12,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL 16OZ BTL","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"2590000088","type":"CDM"},{"code":"259","type":"RC"},{"code":"11917015471A","type":"NDC"}],"standard_charges":[{"gross_charge":53.26,"discounted_cash":21.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 20MG DR TAB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590000089","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268058515A","type":"NDC"}],"standard_charges":[{"gross_charge":18.94,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTOBACILLUS ACIDOPHILUS CAP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000090","type":"CDM"},{"code":"259","type":"RC"},{"code":"77333000450A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PETROLATUM LANOLIN PARAFFINWAX","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000091","type":"CDM"},{"code":"259","type":"RC"},{"code":"098193000174","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ISOSORBIDE DINITRATE/HYDRALAZ","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000092","type":"CDM"},{"code":"259","type":"RC"},{"code":"50742024618A","type":"NDC"}],"standard_charges":[{"gross_charge":16.91,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISOPROSTOL 200 MCG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000093","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762500802A","type":"NDC"}],"standard_charges":[{"gross_charge":5.78,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"Tetrabenazine 12.5mg tab","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2590000109","type":"CDM"},{"code":"259","type":"RC"},{"code":"70436010109B","type":"NDC"}],"standard_charges":[{"gross_charge":373.67,"discounted_cash":149.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOMETHACIN 50MG CAP","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590000150","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268043115A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REFRESH OPTIVE ADVANCE UD DROP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000151","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023449130A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 800MG TAB","drug_information":{"unit":"800","type":"ME"},"code_information":[{"code":"2590000181","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762446001A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CILOSTAZOL 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590000225","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268017715A","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Mirabegron ER 50mg tab","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590000230","type":"CDM"},{"code":"259","type":"RC"},{"code":"00469260230B","type":"NDC"}],"standard_charges":[{"gross_charge":81.59,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE/NALOXONE SL FILM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000275","type":"CDM"},{"code":"259","type":"RC"},{"code":"43598058030A","type":"NDC"}],"standard_charges":[{"gross_charge":35.31,"discounted_cash":14.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE 8MG SL TAB","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2590000276","type":"CDM"},{"code":"259","type":"RC"},{"code":"42858050203A","type":"NDC"}],"standard_charges":[{"gross_charge":39.49,"discounted_cash":15.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Atomoxetine 40mg cap","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590000282","type":"CDM"},{"code":"259","type":"RC"},{"code":"55111052130A","type":"NDC"}],"standard_charges":[{"gross_charge":73.43,"discounted_cash":29.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Amiloride 5mg tab","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590000378","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574029201B","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Quinidine Sulfate 300mg tab","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2590000409","type":"CDM"},{"code":"259","type":"RC"},{"code":"42806051230A","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Atropine Sulfate 1% 0.4ml UD o","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000493","type":"CDM"},{"code":"259","type":"RC"},{"code":"82260000101A","type":"NDC"}],"standard_charges":[{"gross_charge":22.27,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"LEVONORGESTREL 1.5MG TAB","drug_information":{"unit":"1.5","type":"ME"},"code_information":[{"code":"2590000502","type":"CDM"},{"code":"259","type":"RC"},{"code":"50102021116A","type":"NDC"}],"standard_charges":[{"gross_charge":173.53,"discounted_cash":69.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ziprasidone 40mg cap","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590000532","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739000532A","type":"NDC"}],"standard_charges":[{"gross_charge":12.57,"discounted_cash":5.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIROLIMUS 1MG TAB","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590000656","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268071813A","type":"NDC"}],"standard_charges":[{"gross_charge":83.35,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Prochlorperazine Maleate 10mg","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590000685","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268068515A","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 6MG TAB","drug_information":{"unit":"6","type":"ME"},"code_information":[{"code":"2590000700","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054418625A","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Pseudoephedrine 60mg tab","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2590000706","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904690706A","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Terazosin 10mg cap","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590000712","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268076715A","type":"NDC"}],"standard_charges":[{"gross_charge":7.64,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EZ GAS II granules","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590000793","type":"CDM"},{"code":"259","type":"RC"},{"code":"10361079301A","type":"NDC"}],"standard_charges":[{"gross_charge":14.45,"discounted_cash":5.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Estradiol 0.5mg tab","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590000899","type":"CDM"},{"code":"259","type":"RC"},{"code":"00555089902A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Metformin 1000mg tab","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2590000904","type":"CDM"},{"code":"259","type":"RC"},{"code":"70010006501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Benazepril 5mg tab","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590000915","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268010915A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE ODT 0.5 MG","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590001032","type":"CDM"},{"code":"259","type":"RC"},{"code":"59746001032A","type":"NDC"}],"standard_charges":[{"gross_charge":21.69,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISONIAZID 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590001101","type":"CDM"},{"code":"259","type":"RC"},{"code":"64950021610A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIBOFLAVIN 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590001120","type":"CDM"},{"code":"259","type":"RC"},{"code":"54629009501A","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ivabradine 5mg Tab","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590001135","type":"CDM"},{"code":"259","type":"RC"},{"code":"55513080060A","type":"NDC"}],"standard_charges":[{"gross_charge":51.31,"discounted_cash":20.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ticagrelor 60mg tab","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2590001180","type":"CDM"},{"code":"259","type":"RC"},{"code":"00186077660B","type":"NDC"}],"standard_charges":[{"gross_charge":32.66,"discounted_cash":13.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 2.5MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2590001192","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458057710","type":"NDC"}],"standard_charges":[{"gross_charge":35.46,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lokelma 10g pkt","drug_information":{"unit":"10","type":"GM"},"code_information":[{"code":"2590001196","type":"CDM"},{"code":"259","type":"RC"},{"code":"00310111039B","type":"NDC"}],"standard_charges":[{"gross_charge":138.51,"discounted_cash":55.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Linzess 290mcg cap","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590001202","type":"CDM"},{"code":"259","type":"RC"},{"code":"00456120230A","type":"NDC"}],"standard_charges":[{"gross_charge":93.17,"discounted_cash":37.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290 MCG"}]},{"description":"LAMOTRIGINE ER 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590001309","type":"CDM"},{"code":"259","type":"RC"},{"code":"13668034030A","type":"NDC"}],"standard_charges":[{"gross_charge":63.67,"discounted_cash":25.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ABACAVIR SULFATE 300MG TAB","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2590001405","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378410591A","type":"NDC"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":19.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMIVUDINE 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590001406","type":"CDM"},{"code":"259","type":"RC"},{"code":"66993047860A","type":"NDC"}],"standard_charges":[{"gross_charge":77.56,"discounted_cash":31.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOLUTEGRAVIR 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590001407","type":"CDM"},{"code":"259","type":"RC"},{"code":"49702022813A","type":"NDC"}],"standard_charges":[{"gross_charge":330.44,"discounted_cash":132.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Flecainide Acetate 100mg tab","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590001468","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054001120A","type":"NDC"}],"standard_charges":[{"gross_charge":16.18,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Nimodipine 30mg cap","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2590001518","type":"CDM"},{"code":"259","type":"RC"},{"code":"63739079733A","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Buprenorphine 20mcg patch","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590001710","type":"CDM"},{"code":"259","type":"RC"},{"code":"42858083940A","type":"NDC"}],"standard_charges":[{"gross_charge":812.04,"discounted_cash":324.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"}]},{"description":"Acitretin 25mg cap","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590001753","type":"CDM"},{"code":"259","type":"RC"},{"code":"00115175308A","type":"NDC"}],"standard_charges":[{"gross_charge":182.91,"discounted_cash":73.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Empagliflozin 10mg tab","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590001828","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597015237A","type":"NDC"}],"standard_charges":[{"gross_charge":80.21,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200MG TAB","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590001908","type":"CDM"},{"code":"259","type":"RC"},{"code":"00131248060A","type":"NDC"}],"standard_charges":[{"gross_charge":74.6,"discounted_cash":29.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cresemba 186mg caps","drug_information":{"unit":"186","type":"ME"},"code_information":[{"code":"2590002002","type":"CDM"},{"code":"259","type":"RC"},{"code":"00469052002A","type":"NDC"}],"standard_charges":[{"gross_charge":575.06,"discounted_cash":230.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Aloe Vera Gel","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590002010","type":"CDM"},{"code":"259","type":"RC"},{"code":"71661000136A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"Hydromorphone 4mg tab","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2590002100","type":"CDM"},{"code":"259","type":"RC"},{"code":"42858030225A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Dronabinol 5mg cap","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590002101","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527145106A","type":"NDC"}],"standard_charges":[{"gross_charge":54.92,"discounted_cash":21.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Caffeine 200mg tabs","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590002102","type":"CDM"},{"code":"259","type":"RC"},{"code":"46017001816A","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Mirtazapine ODT 15mg tab","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2590002106","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862002106A","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Actidose-Aqua 25g/120ml tube","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"2590002174","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574052174A","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":31.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tacrolimus 0.5mg/ml soln","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590002361","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904662361A","type":"NDC"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Creon-24 cap","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590002401","type":"CDM"},{"code":"259","type":"RC"},{"code":"00032263601A","type":"NDC"}],"standard_charges":[{"gross_charge":42.53,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"Genteal drops","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590002460","type":"CDM"},{"code":"259","type":"RC"},{"code":"00065042636A","type":"NDC"}],"standard_charges":[{"gross_charge":28.48,"discounted_cash":11.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"Biktarvy 50-200-25mg tab","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590002501","type":"CDM"},{"code":"259","type":"RC"},{"code":"61958250101B","type":"NDC"}],"standard_charges":[{"gross_charge":644.79,"discounted_cash":257.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE ODT 2 MG","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2590003022","type":"CDM"},{"code":"259","type":"RC"},{"code":"59746003022A","type":"NDC"}],"standard_charges":[{"gross_charge":39.45,"discounted_cash":15.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 20MG/5ML SOL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590003100","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054372763A","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Melatonin 1mg tab","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590003366","type":"CDM"},{"code":"259","type":"RC"},{"code":"80681004100A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETIRIZINE HCL 5MG/5ML LIQ","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590003607","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094000462A","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Morphine 0.4mg/ml oral","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"2590003749","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054023749E","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Melatonin 5mg tab","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590003901","type":"CDM"},{"code":"259","type":"RC"},{"code":"20555003901A","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Baclofen 5mg Tab","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590004070","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268010515A","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Caplyta 42mg cap","drug_information":{"unit":"42","type":"ME"},"code_information":[{"code":"2590004240","type":"CDM"},{"code":"259","type":"RC"},{"code":"72060014240A","type":"NDC"}],"standard_charges":[{"gross_charge":236.45,"discounted_cash":94.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Quetiapine 400mg tab","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2590004361","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904664361A","type":"NDC"}],"standard_charges":[{"gross_charge":7.23,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Valganciclovir 50mg/mL liq","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590004401","type":"CDM"},{"code":"259","type":"RC"},{"code":"59651044401A","type":"NDC"}],"standard_charges":[{"gross_charge":46.62,"discounted_cash":18.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEEP BLUE RELIEF GEL 4 OZ BTL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590004475","type":"CDM"},{"code":"259","type":"RC"},{"code":"79854074404A","type":"NDC"}],"standard_charges":[{"gross_charge":63.67,"discounted_cash":25.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"BENZTROPINE MESYLATE 0.5MG TAB","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590004500","type":"CDM"},{"code":"259","type":"RC"},{"code":"69315013601A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Valproate Sodium 500mg/10ml cu","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2590005000","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121135000A","type":"NDC"}],"standard_charges":[{"gross_charge":8.67,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Vericiguat 2.5 MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2590005028","type":"CDM"},{"code":"259","type":"RC"},{"code":"00006502801A","type":"NDC"}],"standard_charges":[{"gross_charge":116.19,"discounted_cash":46.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE TOP OINT 25MG/1.2","drug_information":{"unit":"1.2","type":"ML"},"code_information":[{"code":"2590005446","type":"CDM"},{"code":"259","type":"RC"},{"code":"05446134101","type":"NDC"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":19.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Methimazole 5mg tab","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590005701","type":"CDM"},{"code":"259","type":"RC"},{"code":"23155007001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Paliperidone ER 3mg tab","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2590006015","type":"CDM"},{"code":"259","type":"RC"},{"code":"43975035003A","type":"NDC"}],"standard_charges":[{"gross_charge":66.32,"discounted_cash":26.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Rotigotine 4mg patch","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2590006071","type":"CDM"},{"code":"259","type":"RC"},{"code":"50474080403A","type":"NDC"}],"standard_charges":[{"gross_charge":113.45,"discounted_cash":45.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Rufinamide 40mg/mL cup","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590006285","type":"CDM"},{"code":"259","type":"RC"},{"code":"62856058446A","type":"NDC"}],"standard_charges":[{"gross_charge":21.78,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADDERALL 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590006292","type":"CDM"},{"code":"259","type":"RC"},{"code":"13107006801A","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADDERALL 10MG TAB","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590006293","type":"CDM"},{"code":"259","type":"RC"},{"code":"13107007001A","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMETHYLPHENIDATE 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590006294","type":"CDM"},{"code":"259","type":"RC"},{"code":"10702010701A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 600MG","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2590006324","type":"CDM"},{"code":"259","type":"RC"},{"code":"79854004097A","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hydralazine 100mg tab","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590006443","type":"CDM"},{"code":"259","type":"RC"},{"code":"76282031201A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Omeprazole 40mg tab DR","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590006444","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687060801A","type":"NDC"}],"standard_charges":[{"gross_charge":9.73,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 40MG/5ML CUP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590006461","type":"CDM"},{"code":"259","type":"RC"},{"code":"70954031610A","type":"NDC"}],"standard_charges":[{"gross_charge":84.01,"discounted_cash":33.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lacosamide 100mg/10ml solution","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2590006684","type":"CDM"},{"code":"259","type":"RC"},{"code":"00131541072A","type":"NDC"}],"standard_charges":[{"gross_charge":110.02,"discounted_cash":44.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Kurvelo 0.15mg/0.03mg tab","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590006818","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180084473A","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"Prucalopride 2mg tab","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2590006860","type":"CDM"},{"code":"259","type":"RC"},{"code":"54092054701B","type":"NDC"}],"standard_charges":[{"gross_charge":76.89,"discounted_cash":30.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Glutose-15 oral gel","drug_information":{"unit":"15","type":"GM"},"code_information":[{"code":"2590006915","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574006915A","type":"NDC"}],"standard_charges":[{"gross_charge":17.86,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Brivaracetam 100mg tab","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590007009","type":"CDM"},{"code":"259","type":"RC"},{"code":"50474077009A","type":"NDC"}],"standard_charges":[{"gross_charge":120.78,"discounted_cash":48.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Xerava 100mg vial","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590007010","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0122","type":"HCPCS"},{"code":"71773010012A","type":"NDC"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Posaconazole DR 100mg tab","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590007074","type":"CDM"},{"code":"259","type":"RC"},{"code":"70748025807A","type":"NDC"}],"standard_charges":[{"gross_charge":351.27,"discounted_cash":140.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 0.1% OINTMENT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590007510","type":"CDM"},{"code":"259","type":"RC"},{"code":"16729042210A","type":"NDC"}],"standard_charges":[{"gross_charge":1205.09,"discounted_cash":482.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"Rifampin 150mg cap","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590007521","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687057521A","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHAMBUTOL 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590007571","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180028001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Descovy 200mg-25mg tab","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590007723","type":"CDM"},{"code":"259","type":"RC"},{"code":"61958200201B","type":"NDC"}],"standard_charges":[{"gross_charge":366.96,"discounted_cash":146.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Perphenazine 8mg tab","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2590008048","type":"CDM"},{"code":"259","type":"RC"},{"code":"00781804801A","type":"NDC"}],"standard_charges":[{"gross_charge":13.76,"discounted_cash":5.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Morphine ER 60mg tab","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2590008062","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406838062A","type":"NDC"}],"standard_charges":[{"gross_charge":21.81,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lidocaine 4% patch","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590008406","type":"CDM"},{"code":"259","type":"RC"},{"code":"71399388406A","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"Droxidopa 100mg capsule","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590008909","type":"CDM"},{"code":"259","type":"RC"},{"code":"70710138909A","type":"NDC"}],"standard_charges":[{"gross_charge":151.84,"discounted_cash":60.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Venlafaxine 25mg tab","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590009625","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084089625A","type":"NDC"}],"standard_charges":[{"gross_charge":9.36,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Mexiletine 200mg cap","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590009804","type":"CDM"},{"code":"259","type":"RC"},{"code":"50742024001A","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Primaquine 26.3mg tab","drug_information":{"unit":"26.3","type":"ME"},"code_information":[{"code":"2590010201","type":"CDM"},{"code":"259","type":"RC"},{"code":"76385010201B","type":"NDC"}],"standard_charges":[{"gross_charge":8.43,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Methenamine Mandelate 1g tab","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2590010601","type":"CDM"},{"code":"259","type":"RC"},{"code":"42799010601A","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE 0.05% OPS","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"2590010713","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023916330","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EZETIMIBE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010719","type":"CDM"},{"code":"259","type":"RC"},{"code":"67877049030A","type":"NDC"}],"standard_charges":[{"gross_charge":20.65,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE DSINTEGRATING 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010722","type":"CDM"},{"code":"259","type":"RC"},{"code":"55111026281A","type":"NDC"}],"standard_charges":[{"gross_charge":58.66,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAVOPROST 2.5ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010723","type":"CDM"},{"code":"259","type":"RC"},{"code":"66758009556","type":"NDC"}],"standard_charges":[{"gross_charge":338.03,"discounted_cash":135.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"ESTRADIOL V","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010724","type":"CDM"},{"code":"259","type":"RC"},{"code":"00430375414","type":"NDC"}],"standard_charges":[{"gross_charge":1719.46,"discounted_cash":687.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LINEZOLID 600MG T","drug_information":{"unit":"600","type":"ME"},"code_information":[{"code":"2590010725","type":"CDM"},{"code":"259","type":"RC"},{"code":"00009513802A","type":"NDC"}],"standard_charges":[{"gross_charge":612.7,"discounted_cash":245.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010726","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079058106","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGEN 0.9MG T","drug_information":{"unit":"0.9","type":"ME"},"code_information":[{"code":"2590010727","type":"CDM"},{"code":"259","type":"RC"},{"code":"00046110381","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 40MG/ML L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010729","type":"CDM"},{"code":"259","type":"RC"},{"code":"57237015035A","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELETRIPTAN 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590010730","type":"CDM"},{"code":"259","type":"RC"},{"code":"58151036856","type":"NDC"}],"standard_charges":[{"gross_charge":78.72,"discounted_cash":31.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE CR 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590010731","type":"CDM"},{"code":"259","type":"RC"},{"code":"62175047132A","type":"NDC"}],"standard_charges":[{"gross_charge":19.93,"discounted_cash":7.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN 106MG/HCTZ 25MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010732","type":"CDM"},{"code":"259","type":"RC"},{"code":"33342007610A","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"WARFARIN 6MG T","drug_information":{"unit":"6","type":"ME"},"code_information":[{"code":"2590010733","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672403301A","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN 160MG T","drug_information":{"unit":"160","type":"ME"},"code_information":[{"code":"2590010734","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078035934A","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODOQUINOL-HC 30 GM CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010735","type":"CDM"},{"code":"259","type":"RC"},{"code":"52187055130A","type":"NDC"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ENOXAPARIN 80MG/0.8ML I","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2590010737","type":"CDM"},{"code":"259","type":"RC"},{"code":"00548560400A","type":"NDC"}],"standard_charges":[{"gross_charge":90.56,"discounted_cash":36.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 120MG/0.8ML I","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2590010738","type":"CDM"},{"code":"259","type":"RC"},{"code":"00548560600A","type":"NDC"}],"standard_charges":[{"gross_charge":135.84,"discounted_cash":54.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATORVASTATIN 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590010740","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904629261A","type":"NDC"}],"standard_charges":[{"gross_charge":20.56,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESCITALOPRAM 20 MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010741","type":"CDM"},{"code":"259","type":"RC"},{"code":"13668013701A","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 0.175MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010742","type":"CDM"},{"code":"259","type":"RC"},{"code":"42292004020A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 175 MCG"}]},{"description":"THIOTHIXENE 1MG C","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590010744","type":"CDM"},{"code":"259","type":"RC"},{"code":"60219167301A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE 20MG C","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010745","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904626908A","type":"NDC"}],"standard_charges":[{"gross_charge":37.24,"discounted_cash":14.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BECLOMETHASONE 40MCG INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010747","type":"CDM"},{"code":"259","type":"RC"},{"code":"59310030240A","type":"NDC"}],"standard_charges":[{"gross_charge":253.52,"discounted_cash":101.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"RISEDRONATE 35MG T","drug_information":{"unit":"35","type":"ME"},"code_information":[{"code":"2590010748","type":"CDM"},{"code":"259","type":"RC"},{"code":"00430047203","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GATIFLOXACIN 5ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010749","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314067225A","type":"NDC"}],"standard_charges":[{"gross_charge":309.09,"discounted_cash":123.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"MOXIFLOXACIN 3ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010750","type":"CDM"},{"code":"250","type":"RC"},{"code":"82667070003A","type":"NDC"}],"standard_charges":[{"gross_charge":888.75,"discounted_cash":355.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"ALBUTEROL ER 4MG T","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2590010751","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378412201A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARAVEDILOL 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590010752","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079093220A","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE 10/BENAZEPRIL 20 C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010753","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180047201A","type":"NDC"}],"standard_charges":[{"gross_charge":17.51,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"SERTRALINE 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590010754","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687025301A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 90 MG C","drug_information":{"unit":"90","type":"ME"},"code_information":[{"code":"2590010755","type":"CDM"},{"code":"259","type":"RC"},{"code":"55111028448A","type":"NDC"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":38.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL XL 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590010758","type":"CDM"},{"code":"259","type":"RC"},{"code":"45963067711A","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 5MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010759","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904682894A","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLMESARTAN MEDOXOMIL 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010761","type":"CDM"},{"code":"259","type":"RC"},{"code":"62332013230A","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION XL 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590010762","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904750561A","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION XL 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2590010763","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687079321A","type":"NDC"}],"standard_charges":[{"gross_charge":29.04,"discounted_cash":11.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010764","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084074001A","type":"NDC"}],"standard_charges":[{"gross_charge":79.36,"discounted_cash":31.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX ER 250MG T","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2590010765","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079076608","type":"NDC"}],"standard_charges":[{"gross_charge":7.78,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 100MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010766","type":"CDM"},{"code":"259","type":"RC"},{"code":"00009513601","type":"NDC"}],"standard_charges":[{"gross_charge":84.86,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN E 200 IU C","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"2590010768","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268086915A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZONISAMIDE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590010769","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687023001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAKINS SOL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010771","type":"CDM"},{"code":"259","type":"RC"},{"code":"00436094616","type":"NDC"}],"standard_charges":[{"gross_charge":45.28,"discounted_cash":18.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TOBRAMYCIN 3.5GM OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010772","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078081301A","type":"NDC"}],"standard_charges":[{"gross_charge":263.94,"discounted_cash":105.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"GALANTAMINE 8MG T","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2590010773","type":"CDM"},{"code":"259","type":"RC"},{"code":"57237005060A","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALANTAMINE 12MG T","drug_information":{"unit":"12","type":"ME"},"code_information":[{"code":"2590010774","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862046060A","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAMPHOR/METHOL LOTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010775","type":"CDM"},{"code":"259","type":"RC"},{"code":"46122057310A","type":"NDC"}],"standard_charges":[{"gross_charge":44.57,"discounted_cash":17.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CALCIUM 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590010776","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904188361","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALSALAZIDE 750MG C","drug_information":{"unit":"750","type":"ME"},"code_information":[{"code":"2590010777","type":"CDM"},{"code":"259","type":"RC"},{"code":"65649010102","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN/CLAVULANATE XR1000","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2590010781","type":"CDM"},{"code":"259","type":"RC"},{"code":"43598002028","type":"NDC"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEMANTINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010782","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904650561A","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEMANTINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010784","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591387544A","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR 12MG/ML L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010785","type":"CDM"},{"code":"259","type":"RC"},{"code":"00004082205A","type":"NDC"}],"standard_charges":[{"gross_charge":9.73,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROLAMINE 85 GRAM CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010787","type":"CDM"},{"code":"259","type":"RC"},{"code":"41167057003A","type":"NDC"}],"standard_charges":[{"gross_charge":21.26,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"METOCLOPRAMIDE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010788","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093220401A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN ER 650MG T","drug_information":{"unit":"650","type":"ME"},"code_information":[{"code":"2590010790","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268005215A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE 25MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010791","type":"CDM"},{"code":"259","type":"RC"},{"code":"00069097065","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIOTROPIUM 18MCG INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010792","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597007575","type":"NDC"}],"standard_charges":[{"gross_charge":448.56,"discounted_cash":179.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"LEVETIRACETAM 250MG L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010793","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904726592A","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVASTATIN 40 MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590010795","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180046901A","type":"NDC"}],"standard_charges":[{"gross_charge":22.54,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 80MG T","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2590010798","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180046506A","type":"NDC"}],"standard_charges":[{"gross_charge":24.54,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMOZOLOMIDE 100 MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590010800","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8700","type":"HCPCS"},{"code":"16729005053A","type":"NDC"}],"standard_charges":[{"gross_charge":731.62,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMOZOLOMIDE 20 MG C","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010801","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8700","type":"HCPCS"},{"code":"16729004953A","type":"NDC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMOZOLOMIDE 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010802","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8700","type":"HCPCS"},{"code":"16729004854A","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METAXALONE 800MG T","drug_information":{"unit":"800","type":"ME"},"code_information":[{"code":"2590010804","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527143501A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOP 25MG/LEVODOP 100MG CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010806","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079097820A","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"ERYTHROMYCIN 1 GRAM OPO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010807","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208091019A","type":"NDC"}],"standard_charges":[{"gross_charge":48.51,"discounted_cash":19.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"EPLERENONE 25 MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590010808","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762110702","type":"NDC"}],"standard_charges":[{"gross_charge":20.59,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTROGEN  CONJ 0.45MG T","drug_information":{"unit":"0.45","type":"ME"},"code_information":[{"code":"2590010809","type":"CDM"},{"code":"259","type":"RC"},{"code":"00046110181","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHNYL/CHRPHN/DXTRO/GUIF 5ML UD","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010812","type":"CDM"},{"code":"259","type":"RC"},{"code":"68047018616A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETH 30/GUAIFEN 600 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010813","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536116137A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AQUAPHOR OINT 50 GRM TUBE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010814","type":"CDM"},{"code":"259","type":"RC"},{"code":"72140003147A","type":"NDC"}],"standard_charges":[{"gross_charge":19.41,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"DULOXETINE 30MG C","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2590010816","type":"CDM"},{"code":"259","type":"RC"},{"code":"00228289103A","type":"NDC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Insulin Regular","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010817","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002021301A","type":"NDC"}],"standard_charges":[{"gross_charge":29.7,"discounted_cash":11.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN  HUMAN (NPH) I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010818","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002831501A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN  NPH/REG 70/30 I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010820","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002871517A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN  ASPART/ASPART PROT I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010821","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00169368512","type":"NDC"}],"standard_charges":[{"gross_charge":37.04,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE 0.1% 454 GRM OIN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010823","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168000616","type":"NDC"}],"standard_charges":[{"gross_charge":142.39,"discounted_cash":56.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"TRIAMCINOLONE 0.1% 60 ML LOTIO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010824","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713067653A","type":"NDC"}],"standard_charges":[{"gross_charge":205.04,"discounted_cash":82.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"FLUOCINONIDE 0.05% 30 GRAM CRE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010825","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672138601A","type":"NDC"}],"standard_charges":[{"gross_charge":216.21,"discounted_cash":86.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"FLUOCINONIDE 0.05% 30 GRAM OIN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010826","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672126401A","type":"NDC"}],"standard_charges":[{"gross_charge":258.15,"discounted_cash":103.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"FLUOCINONIDE 0.05% 60ML LOTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010827","type":"CDM"},{"code":"259","type":"RC"},{"code":"21922000101A","type":"NDC"}],"standard_charges":[{"gross_charge":419.07,"discounted_cash":167.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CLOBETASOL 0.05% 30 GRAM CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010828","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168016330","type":"NDC"}],"standard_charges":[{"gross_charge":1065.77,"discounted_cash":426.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CLOBETASOL 0.05% 30 GRAM OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010829","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672125902","type":"NDC"}],"standard_charges":[{"gross_charge":1079.49,"discounted_cash":431.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CLOBETASOL 0.05% 50 ML LOTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010830","type":"CDM"},{"code":"259","type":"RC"},{"code":"00168026950","type":"NDC"}],"standard_charges":[{"gross_charge":321.83,"discounted_cash":128.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CLONAZEPAM WAFER 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590010832","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884030802","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 2O MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010834","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084039201","type":"NDC"}],"standard_charges":[{"gross_charge":10.63,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN/TRIAMCINOLONE 30GR CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010835","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"gross_charge":167.16,"discounted_cash":66.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"NYSTATIN/TRIAMCINOLONE 30GR OI","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010836","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672127202","type":"NDC"}],"standard_charges":[{"gross_charge":130.81,"discounted_cash":52.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"PRAMIPEXOLE 1.5 MG T","drug_information":{"unit":"1.5","type":"ME"},"code_information":[{"code":"2590010838","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597019190","type":"NDC"}],"standard_charges":[{"gross_charge":17.14,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRINZOLAMIDE 10ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010839","type":"CDM"},{"code":"259","type":"RC"},{"code":"66758008570","type":"NDC"}],"standard_charges":[{"gross_charge":496.64,"discounted_cash":198.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"OXCARBAZEPINE 300MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010840","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078035752","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALIVA SUBSTITUTE 120ML BTL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010841","type":"CDM"},{"code":"259","type":"RC"},{"code":"48582051201A","type":"NDC"}],"standard_charges":[{"gross_charge":36.88,"discounted_cash":14.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ROPINIROLE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590010842","type":"CDM"},{"code":"259","type":"RC"},{"code":"62332003231A","type":"NDC"}],"standard_charges":[{"gross_charge":9.02,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPINIROLE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2590010843","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268074415A","type":"NDC"}],"standard_charges":[{"gross_charge":9.18,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 4 GM/60ML R","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"2590010844","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802009851","type":"NDC"}],"standard_charges":[{"gross_charge":89.13,"discounted_cash":35.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALFUZOSIN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010845","type":"CDM"},{"code":"259","type":"RC"},{"code":"47335095688A","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFDINIR 125MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010846","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180072205","type":"NDC"}],"standard_charges":[{"gross_charge":24.31,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOXYMETHYLCELLULOSE OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010847","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023079815","type":"NDC"}],"standard_charges":[{"gross_charge":54.48,"discounted_cash":21.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"METFORMIN 500MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010849","type":"CDM"},{"code":"259","type":"RC"},{"code":"10631020602A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN 20MG NASAL SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010852","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527185943A","type":"NDC"}],"standard_charges":[{"gross_charge":803.72,"discounted_cash":321.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ARIPIPRAZOLE 10 MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010853","type":"CDM"},{"code":"259","type":"RC"},{"code":"59148000813A","type":"NDC"}],"standard_charges":[{"gross_charge":83.79,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSYLLIUM 0.52GM C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010856","type":"CDM"},{"code":"259","type":"RC"},{"code":"37000074087","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROSUVASTATIN 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010857","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687024501A","type":"NDC"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":8.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROSUVASTATIN 20MG T","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010858","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687025601A","type":"NDC"}],"standard_charges":[{"gross_charge":21.97,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROSUVASTATIN 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010860","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687023401A","type":"NDC"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXEMESTANE 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590010861","type":"CDM"},{"code":"259","type":"RC"},{"code":"00009766304","type":"NDC"}],"standard_charges":[{"gross_charge":64.08,"discounted_cash":25.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 10MG/ACETAMI 325MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010862","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406052362","type":"NDC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LISINOPRIL 40MG T","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590010863","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687067801A","type":"NDC"}],"standard_charges":[{"gross_charge":10.73,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DONEPEZIL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010864","type":"CDM"},{"code":"259","type":"RC"},{"code":"62756044581A","type":"NDC"}],"standard_charges":[{"gross_charge":41.53,"discounted_cash":16.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN 80MG/HCTZ 12.5MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010865","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078031434A","type":"NDC"}],"standard_charges":[{"gross_charge":14.29,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"SOTALOL 120MG T","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2590010867","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505015900A","type":"NDC"}],"standard_charges":[{"gross_charge":16.23,"discounted_cash":6.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN XL 15MG T","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2590010868","type":"CDM"},{"code":"259","type":"RC"},{"code":"62175027237A","type":"NDC"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN 3.9MG PAT","drug_information":{"unit":"3.9","type":"ME"},"code_information":[{"code":"2590010869","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023615308","type":"NDC"}],"standard_charges":[{"gross_charge":92.61,"discounted_cash":37.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010870","type":"CDM"},{"code":"259","type":"RC"},{"code":"70677115201A","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NILUTAMIDE 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590010871","type":"CDM"},{"code":"259","type":"RC"},{"code":"62559017331A","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUVASTATIN 40MG C","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590010873","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378802177A","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID/VIT B6 T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010874","type":"CDM"},{"code":"259","type":"RC"},{"code":"51991038490","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUNISOLIDE NASAL 25ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010876","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208034425A","type":"NDC"}],"standard_charges":[{"gross_charge":224.58,"discounted_cash":89.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ECONAZOLE NITRATE 1% 15 GRAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010877","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802046635A","type":"NDC"}],"standard_charges":[{"gross_charge":94.93,"discounted_cash":37.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"BUDESONIDE 3MG C","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2590010879","type":"CDM"},{"code":"259","type":"RC"},{"code":"65162077810A","type":"NDC"}],"standard_charges":[{"gross_charge":94.77,"discounted_cash":37.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATORVASTATIN 80MG T","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2590010881","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904629304A","type":"NDC"}],"standard_charges":[{"gross_charge":20.55,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAXIMIN 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590010882","type":"CDM"},{"code":"259","type":"RC"},{"code":"65649030103A","type":"NDC"}],"standard_charges":[{"gross_charge":45.1,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CITRATE 950MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010884","type":"CDM"},{"code":"259","type":"RC"},{"code":"35046000155A","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"PIMECROLIMUS 30 GRAM CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010886","type":"CDM"},{"code":"259","type":"RC"},{"code":"00187510001","type":"NDC"}],"standard_charges":[{"gross_charge":333.4,"discounted_cash":133.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ESZOPICLONE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590010887","type":"CDM"},{"code":"259","type":"RC"},{"code":"80725001030","type":"NDC"}],"standard_charges":[{"gross_charge":22.77,"discounted_cash":9.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMIDE PEROXIDE OTIC 15ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010888","type":"CDM"},{"code":"259","type":"RC"},{"code":"42037010479A","type":"NDC"}],"standard_charges":[{"gross_charge":21.92,"discounted_cash":8.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"GABAPENTIN 250MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010890","type":"CDM"},{"code":"259","type":"RC"},{"code":"42192060816A","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESZOPICLONE 3MG T","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2590010891","type":"CDM"},{"code":"259","type":"RC"},{"code":"63402019310","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":12.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM 0.03% NASL 30MLBTL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010892","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208039830","type":"NDC"}],"standard_charges":[{"gross_charge":346.25,"discounted_cash":138.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"MEGESTROL 400MG/10ML UD","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2590010893","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094006362A","type":"NDC"}],"standard_charges":[{"gross_charge":37.5,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN 50MG C","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590010894","type":"CDM"},{"code":"259","type":"RC"},{"code":"58151023788","type":"NDC"}],"standard_charges":[{"gross_charge":14.81,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DUTASTERIDE 0.5MG C","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590010895","type":"CDM"},{"code":"259","type":"RC"},{"code":"80725071215","type":"NDC"}],"standard_charges":[{"gross_charge":19.32,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 30MG ODT","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2590010896","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862002206","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL 15 GRAM INHO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010900","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591292754A","type":"NDC"}],"standard_charges":[{"gross_charge":249.13,"discounted_cash":99.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"DULOXETINE 20MG C","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010901","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180029407A","type":"NDC"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESONIDE 0.05% LOTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010906","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672407904A","type":"NDC"}],"standard_charges":[{"gross_charge":1230.56,"discounted_cash":492.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"FISH OIL 1000MG C","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2590010909","type":"CDM"},{"code":"259","type":"RC"},{"code":"00904723860A","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONAZEPAM 0.25MG T","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2590010910","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884030702","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORID 1000MG T","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2590010911","type":"CDM"},{"code":"259","type":"RC"},{"code":"00223176001","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLPIDEM CR 6.25MG T","drug_information":{"unit":"6.25","type":"ME"},"code_information":[{"code":"2590010912","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180077904A","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISRADIPINE 5MG C","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010913","type":"CDM"},{"code":"259","type":"RC"},{"code":"16252054001","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 800MG C","drug_information":{"unit":"800","type":"ME"},"code_information":[{"code":"2590010914","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268006215A","type":"NDC"}],"standard_charges":[{"gross_charge":80.35,"discounted_cash":32.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBANDRONATE 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590010915","type":"CDM"},{"code":"259","type":"RC"},{"code":"33342015053A","type":"NDC"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMELTEON 8MG T","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2590010916","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764080530","type":"NDC"}],"standard_charges":[{"gross_charge":19.68,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOLIFENACIN 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010917","type":"CDM"},{"code":"259","type":"RC"},{"code":"51248015001","type":"NDC"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":10.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOFETILIDE 0.125MG C","drug_information":{"unit":"0.125","type":"ME"},"code_information":[{"code":"2590010918","type":"CDM"},{"code":"259","type":"RC"},{"code":"72205003960A","type":"NDC"}],"standard_charges":[{"gross_charge":17.76,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOFETILIDE 0.5MG C","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590010919","type":"CDM"},{"code":"259","type":"RC"},{"code":"72205004160A","type":"NDC"}],"standard_charges":[{"gross_charge":17.76,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOFETILIDE 0.25MG C","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2590010920","type":"CDM"},{"code":"259","type":"RC"},{"code":"72205004060A","type":"NDC"}],"standard_charges":[{"gross_charge":17.76,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETH GLYCOL/PROPYL 15ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010922","type":"CDM"},{"code":"259","type":"RC"},{"code":"00536121994A","type":"NDC"}],"standard_charges":[{"gross_charge":35.08,"discounted_cash":14.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CYPROHEPTADINE 2MG/5ML L","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590010923","type":"CDM"},{"code":"259","type":"RC"},{"code":"64980050448A","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEGA3 ACID ETHYL ESTERS 1GM C","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"2590010924","type":"CDM"},{"code":"259","type":"RC"},{"code":"64380076111A","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590010927","type":"CDM"},{"code":"259","type":"RC"},{"code":"76385012301A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL 25MG T","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590010928","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079025520","type":"NDC"}],"standard_charges":[{"gross_charge":6.69,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE45/SALMETEROL21 INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010929","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173071520","type":"NDC"}],"standard_charges":[{"gross_charge":702.68,"discounted_cash":281.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"FLUTICASONE115/SALMETEROL21 IN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010930","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173071620","type":"NDC"}],"standard_charges":[{"gross_charge":731.62,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"FLUTICASONE230/SALMETEROL21 IN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010931","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173071720","type":"NDC"}],"standard_charges":[{"gross_charge":916.84,"discounted_cash":366.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"CIPROFLOXACIN/DEXAMETHASONE OT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010933","type":"CDM"},{"code":"259","type":"RC"},{"code":"16714062801A","type":"NDC"}],"standard_charges":[{"gross_charge":1000.2,"discounted_cash":400.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"SALSALATE 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590010935","type":"CDM"},{"code":"259","type":"RC"},{"code":"75854020110A","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE SR 325MG C","drug_information":{"unit":"325","type":"ME"},"code_information":[{"code":"2590010936","type":"CDM"},{"code":"259","type":"RC"},{"code":"69680013160A","type":"NDC"}],"standard_charges":[{"gross_charge":34.56,"discounted_cash":13.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590010937","type":"CDM"},{"code":"259","type":"RC"},{"code":"00071101541","type":"NDC"}],"standard_charges":[{"gross_charge":14.87,"discounted_cash":5.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010939","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378022101","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARENICLINE 0.5MG T","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590010940","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884015576A","type":"NDC"}],"standard_charges":[{"gross_charge":26.1,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARENICLINE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590010941","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884015676A","type":"NDC"}],"standard_charges":[{"gross_charge":26.1,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARIFENACIN 7.5MG T","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2590010943","type":"CDM"},{"code":"259","type":"RC"},{"code":"69097043102A","type":"NDC"}],"standard_charges":[{"gross_charge":19.68,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITAGLIPTIN 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590010944","type":"CDM"},{"code":"259","type":"RC"},{"code":"00006027728","type":"NDC"}],"standard_charges":[{"gross_charge":28.86,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LUBIPROSTONE 24MCG C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010945","type":"CDM"},{"code":"259","type":"RC"},{"code":"42291047660A","type":"NDC"}],"standard_charges":[{"gross_charge":19.89,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"}]},{"description":"DOCOSANOL 2 GRAM CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010946","type":"CDM"},{"code":"259","type":"RC"},{"code":"00135020001","type":"NDC"}],"standard_charges":[{"gross_charge":88.04,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CARVEDILOL CR 10 C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010947","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505367803A","type":"NDC"}],"standard_charges":[{"gross_charge":19.8,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN CHILDRENS CHEW T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010948","type":"CDM"},{"code":"259","type":"RC"},{"code":"80681004900A","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"CARVEDILOL CR 20MG C","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590010949","type":"CDM"},{"code":"259","type":"RC"},{"code":"80725038513","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE80/FORMOTEROL4.5INHL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010950","type":"CDM"},{"code":"259","type":"RC"},{"code":"00186037228","type":"NDC"}],"standard_charges":[{"gross_charge":790.59,"discounted_cash":316.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"BUDESONIDE160/FORMOTEROL4.5INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010951","type":"CDM"},{"code":"259","type":"RC"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"gross_charge":1109.09,"discounted_cash":443.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"DOXERCALCIFEROL 0.5MG C","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010953","type":"CDM"},{"code":"259","type":"RC"},{"code":"62135045030A","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"VORICONAZOLE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590010954","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462057330A","type":"NDC"}],"standard_charges":[{"gross_charge":231.43,"discounted_cash":92.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDODRINE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590010956","type":"CDM"},{"code":"259","type":"RC"},{"code":"00245021211A","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOMETASONE INHALER","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010957","type":"CDM"},{"code":"259","type":"RC"},{"code":"78206011403A","type":"NDC"}],"standard_charges":[{"gross_charge":421.23,"discounted_cash":168.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"TRETINOIN 10MG C","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590010958","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084007521B","type":"NDC"}],"standard_charges":[{"gross_charge":138.92,"discounted_cash":55.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 12MCG PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010959","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378911998A","type":"NDC"}],"standard_charges":[{"gross_charge":96.35,"discounted_cash":38.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MCG"}]},{"description":"SILDENAFIL 50MG T","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590010960","type":"CDM"},{"code":"259","type":"RC"},{"code":"00069421030","type":"NDC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANTHANUM 1000MG T","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"2590010961","type":"CDM"},{"code":"259","type":"RC"},{"code":"54092025490","type":"NDC"}],"standard_charges":[{"gross_charge":35.55,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN GLULISINE 100 UN/1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010962","type":"CDM"},{"code":"259","type":"RC"},{"code":"00088250033","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 17 GRM POW","drug_information":{"unit":"119","type":"GM"},"code_information":[{"code":"2590010963","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802086801","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERGOCALCIFEROL 50000U C","drug_information":{"unit":"50000","type":"UN"},"code_information":[{"code":"2590010964","type":"CDM"},{"code":"259","type":"RC"},{"code":"69452015120A","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIAFINE WOUND DRESS 45 GRAM TO","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010965","type":"CDM"},{"code":"259","type":"RC"},{"code":"00187511045","type":"NDC"}],"standard_charges":[{"gross_charge":284.78,"discounted_cash":113.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"MAFENIDE ACE 50GM PKT","drug_information":{"unit":"50","type":"GM"},"code_information":[{"code":"2590010966","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079062485","type":"NDC"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 10MG/0.8ML I","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"2590010967","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"00781347695A","type":"NDC"}],"standard_charges":[{"gross_charge":566.08,"discounted_cash":226.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBENDAZOLE 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590010969","type":"CDM"},{"code":"259","type":"RC"},{"code":"31722093502A","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOTEPREDNOL 0.2 OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010970","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208035305","type":"NDC"}],"standard_charges":[{"gross_charge":325.29,"discounted_cash":130.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"LOTEPREDNOL 0.5 OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010971","type":"CDM"},{"code":"259","type":"RC"},{"code":"62756023290A","type":"NDC"}],"standard_charges":[{"gross_charge":269.72,"discounted_cash":107.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"FONDAPARINUX 7.5MG I","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"2590010972","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"00781346595A","type":"NDC"}],"standard_charges":[{"gross_charge":452.63,"discounted_cash":181.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POSACONAZOLE 40MG/ML L","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590010974","type":"CDM"},{"code":"259","type":"RC"},{"code":"00085132801","type":"NDC"}],"standard_charges":[{"gross_charge":20.84,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROMETHOLONE OPTH OINT 3.5G","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010976","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023031604","type":"NDC"}],"standard_charges":[{"gross_charge":135.44,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"PREGABALIN 75MG C","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2590010977","type":"CDM"},{"code":"259","type":"RC"},{"code":"00071101441","type":"NDC"}],"standard_charges":[{"gross_charge":11.96,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 75MG T","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2590010978","type":"CDM"},{"code":"259","type":"RC"},{"code":"16571020110A","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACCHAROMYCS BOULRDII LYO 250M","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"2590010979","type":"CDM"},{"code":"259","type":"RC"},{"code":"04142000007","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIFLUOPERAZINE 1MG T","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590010980","type":"CDM"},{"code":"259","type":"RC"},{"code":"51079057220","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 90MCG INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010981","type":"CDM"},{"code":"259","type":"RC"},{"code":"61269050906A","type":"NDC"}],"standard_charges":[{"gross_charge":391.28,"discounted_cash":156.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"BUDESONIDE 180MCG INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010982","type":"CDM"},{"code":"259","type":"RC"},{"code":"61269051812A","type":"NDC"}],"standard_charges":[{"gross_charge":524.4,"discounted_cash":209.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"CHLORAMBUCIL 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2590010984","type":"CDM"},{"code":"259","type":"RC"},{"code":"S0172","type":"HCPCS"},{"code":"80725061025A","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CINACALCET 30MG T","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"2590010985","type":"CDM"},{"code":"259","type":"RC"},{"code":"55513007330","type":"NDC"}],"standard_charges":[{"gross_charge":60.33,"discounted_cash":24.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOPIDOGREL 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2590010986","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084075225A","type":"NDC"}],"standard_charges":[{"gross_charge":98.97,"discounted_cash":39.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RANOLAZINE 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590010988","type":"CDM"},{"code":"259","type":"RC"},{"code":"50228042360A","type":"NDC"}],"standard_charges":[{"gross_charge":17.57,"discounted_cash":7.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFABUTIN 150MG C","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590010989","type":"CDM"},{"code":"259","type":"RC"},{"code":"70954004110A","type":"NDC"}],"standard_charges":[{"gross_charge":39.36,"discounted_cash":15.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZELASTINE 0.05% 6ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010990","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505057804","type":"NDC"}],"standard_charges":[{"gross_charge":488.05,"discounted_cash":195.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"TRIFLURIDINE 1% 7.5ML OPTH SOL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010991","type":"CDM"},{"code":"259","type":"RC"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"gross_charge":652.43,"discounted_cash":260.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"RIVASTIGMINE 4.6MG PAT","drug_information":{"unit":"4.6","type":"ME"},"code_information":[{"code":"2590010992","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078050115","type":"NDC"}],"standard_charges":[{"gross_charge":35.08,"discounted_cash":14.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRMONIDNE.2%/TMOLOL.5%10ML OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010993","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023921105A","type":"NDC"}],"standard_charges":[{"gross_charge":677.06,"discounted_cash":270.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"RIVASTIGMINE 9.5MG PATCH","drug_information":{"unit":"9.5","type":"ME"},"code_information":[{"code":"2590010994","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078050215","type":"NDC"}],"standard_charges":[{"gross_charge":35.08,"discounted_cash":14.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALMOTRIPTAN 12.5MG T","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2590010995","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378524685A","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC EPOLAMINE PATCH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590010997","type":"CDM"},{"code":"259","type":"RC"},{"code":"59762070702A","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ALVIMOPAN 12MG C","drug_information":{"unit":"12","type":"ME"},"code_information":[{"code":"2590010999","type":"CDM"},{"code":"259","type":"RC"},{"code":"00254301255A","type":"NDC"}],"standard_charges":[{"gross_charge":771.91,"discounted_cash":308.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERLOTINIB 100MG T","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590011000","type":"CDM"},{"code":"259","type":"RC"},{"code":"62332056630A","type":"NDC"}],"standard_charges":[{"gross_charge":493.15,"discounted_cash":197.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEBIVOLOL 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590011001","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687064121A","type":"NDC"}],"standard_charges":[{"gross_charge":8.91,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIACIN 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590011002","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093739286A","type":"NDC"}],"standard_charges":[{"gross_charge":9.32,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRASUGREL 10MG T","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590011003","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687088321A","type":"NDC"}],"standard_charges":[{"gross_charge":78.76,"discounted_cash":31.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM 99MG T","drug_information":{"unit":"595","type":"ME"},"code_information":[{"code":"2590011004","type":"CDM"},{"code":"259","type":"RC"},{"code":"74312001110B","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN D 1000 U T","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"2590011005","type":"CDM"},{"code":"259","type":"RC"},{"code":"20555003300A","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE 0.1% CREAM 454 G","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011006","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802006405","type":"NDC"}],"standard_charges":[{"gross_charge":142.39,"discounted_cash":56.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"ALISKIREN 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590011007","type":"CDM"},{"code":"259","type":"RC"},{"code":"70839015030","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALISKIREN 300MG T","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"2590011008","type":"CDM"},{"code":"259","type":"RC"},{"code":"70839030030A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 0.5MG C","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590011009","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084044901A","type":"NDC"}],"standard_charges":[{"gross_charge":10.58,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE 2MG T","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2590011010","type":"CDM"},{"code":"259","type":"RC"},{"code":"59148000613","type":"NDC"}],"standard_charges":[{"gross_charge":81.3,"discounted_cash":32.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE 5MG T","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590011011","type":"CDM"},{"code":"259","type":"RC"},{"code":"59148000713A","type":"NDC"}],"standard_charges":[{"gross_charge":81.3,"discounted_cash":32.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NISOLDIPINE 8.5MG T","drug_information":{"unit":"8.5","type":"ME"},"code_information":[{"code":"2590011012","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378209601A","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE 0.1% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011014","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023932105","type":"NDC"}],"standard_charges":[{"gross_charge":328.62,"discounted_cash":131.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"BRIMONIDINE 0.2% OPS","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011015","type":"CDM"},{"code":"259","type":"RC"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":86.05,"discounted_cash":34.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CICLESONIDE 160MCG INHN","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011016","type":"CDM"},{"code":"259","type":"RC"},{"code":"70515071201","type":"NDC"}],"standard_charges":[{"gross_charge":571.87,"discounted_cash":228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"FLUCYTOSINE 500MG C","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590011017","type":"CDM"},{"code":"259","type":"RC"},{"code":"59651033201A","type":"NDC"}],"standard_charges":[{"gross_charge":163.22,"discounted_cash":65.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE 100MG C","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590011018","type":"CDM"},{"code":"259","type":"RC"},{"code":"00115443301","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS ASCORBATE T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011019","type":"CDM"},{"code":"259","type":"RC"},{"code":"63717009901","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"POTASSIUM PHOSPHATE 500MG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011020","type":"CDM"},{"code":"259","type":"RC"},{"code":"00486111101","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"SORAFENIB 200MG T","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590011021","type":"CDM"},{"code":"259","type":"RC"},{"code":"50419048901","type":"NDC"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE .125% NASAL 15ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011022","type":"CDM"},{"code":"259","type":"RC"},{"code":"56184012105","type":"NDC"}],"standard_charges":[{"gross_charge":13.89,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"DRONEDARONE 400MG T","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2590011023","type":"CDM"},{"code":"259","type":"RC"},{"code":"00024414260","type":"NDC"}],"standard_charges":[{"gross_charge":20.51,"discounted_cash":8.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESVENLAFAXINE 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590011025","type":"CDM"},{"code":"259","type":"RC"},{"code":"00008121101","type":"NDC"}],"standard_charges":[{"gross_charge":21.36,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RILUZOLE 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590011026","type":"CDM"},{"code":"259","type":"RC"},{"code":"62756053886A","type":"NDC"}],"standard_charges":[{"gross_charge":69.46,"discounted_cash":27.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIOTHYRONINE 25 MCG T","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011027","type":"CDM"},{"code":"259","type":"RC"},{"code":"60793011601A","type":"NDC"}],"standard_charges":[{"gross_charge":8.07,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"}]},{"description":"LUBIPROSTONE 8 MCG CAPSULE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011029","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764008060","type":"NDC"}],"standard_charges":[{"gross_charge":19.89,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"PRAMIPEXOLE 0.25MG TAB","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"2590011030","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597018461","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN 0.2MG TAB","drug_information":{"unit":"0.2","type":"ME"},"code_information":[{"code":"2590011031","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505025801A","type":"NDC"}],"standard_charges":[{"gross_charge":33.14,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALANTAMINE 24MG CAPSULE","drug_information":{"unit":"24","type":"ME"},"code_information":[{"code":"2590011032","type":"CDM"},{"code":"259","type":"RC"},{"code":"47335083783A","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE ACETATE W/PRAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011033","type":"CDM"},{"code":"259","type":"RC"},{"code":"45802047264","type":"NDC"}],"standard_charges":[{"gross_charge":231.86,"discounted_cash":92.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"RIFAXIMIN 550MG TAB","drug_information":{"unit":"550","type":"ME"},"code_information":[{"code":"2590011036","type":"CDM"},{"code":"259","type":"RC"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":184.49,"discounted_cash":73.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROSPIUM CHLORIDE XR 60MG","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2590011037","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591363630A","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMCICLOVIR 500MG TABLET","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590011039","type":"CDM"},{"code":"259","type":"RC"},{"code":"00093811956","type":"NDC"}],"standard_charges":[{"gross_charge":59.88,"discounted_cash":23.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE 1% 5GM GEL PACKET","drug_information":{"unit":"5","type":"GM"},"code_information":[{"code":"2590011040","type":"CDM"},{"code":"259","type":"RC"},{"code":"00051845030","type":"NDC"}],"standard_charges":[{"gross_charge":50.13,"discounted_cash":20.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FEBUXOSTAT 40MG TABLET","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590011042","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764091830","type":"NDC"}],"standard_charges":[{"gross_charge":27.96,"discounted_cash":11.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CICLESONIDE 50MCG SPY (OMNARIS","drug_information":{"unit":"12.5","type":"GM"},"code_information":[{"code":"2590011043","type":"CDM"},{"code":"259","type":"RC"},{"code":"70515070101","type":"NDC"}],"standard_charges":[{"gross_charge":295.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANISETRON 1MG TAB","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590011045","type":"CDM"},{"code":"259","type":"RC"},{"code":"S0091","type":"HCPCS"},{"code":"51991073520A","type":"NDC"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":62.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYPOCHLOR 0.125%","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011046","type":"CDM"},{"code":"259","type":"RC"},{"code":"00436067216","type":"NDC"}],"standard_charges":[{"gross_charge":53.36,"discounted_cash":21.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"POTASS CITRATE 5mEq TAB 540MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011047","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591268201A","type":"NDC"}],"standard_charges":[{"gross_charge":40.52,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MEQ"}]},{"description":"MERCAPTOPURINE 50MG TABLET","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590011048","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054458111","type":"NDC"}],"standard_charges":[{"gross_charge":148.18,"discounted_cash":59.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVELAMER CARBONATE 2.4GM PKT","drug_information":{"unit":"2.4","type":"GM"},"code_information":[{"code":"2590011049","type":"CDM"},{"code":"259","type":"RC"},{"code":"58468013102","type":"NDC"}],"standard_charges":[{"gross_charge":36.16,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDIALYTE 8OZ BTL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011050","type":"CDM"},{"code":"259","type":"RC"},{"code":"24385021634","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 OZ"}]},{"description":"PALIPERIDONE 9MG TAB","drug_information":{"unit":"9","type":"ME"},"code_information":[{"code":"2590011051","type":"CDM"},{"code":"259","type":"RC"},{"code":"43975035203A","type":"NDC"}],"standard_charges":[{"gross_charge":92.61,"discounted_cash":37.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TAPENTADOL 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590011054","type":"CDM"},{"code":"259","type":"RC"},{"code":"24510005010","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 2MG/1ML UD LIQUID","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590011056","type":"CDM"},{"code":"259","type":"RC"},{"code":"68094076462A","type":"NDC"}],"standard_charges":[{"gross_charge":18.21,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE/ACETMNPHN 5MG/325G","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011057","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406012362A","type":"NDC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"HYDROCDNE/ACTMNPHN 7.5MG/325MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011058","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687040701A","type":"NDC"}],"standard_charges":[{"gross_charge":4.43,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"HYDROCDNE/ACETMPHN 10MG/325MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011059","type":"CDM"},{"code":"259","type":"RC"},{"code":"00406012562A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LAMVUDNE 150MG/ZIDVUDNE 300MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011060","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862003660A","type":"NDC"}],"standard_charges":[{"gross_charge":50.94,"discounted_cash":20.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPINAVIR 200MG/RITONAVIR 50MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011061","type":"CDM"},{"code":"259","type":"RC"},{"code":"00074300860","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EMTRCTABNE 200MG/TENOFVR 300MG","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011062","type":"CDM"},{"code":"259","type":"RC"},{"code":"61958070101A","type":"NDC"}],"standard_charges":[{"gross_charge":318.15,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"DONEPEZIL HCL 23MG TAB","drug_information":{"unit":"23","type":"ME"},"code_information":[{"code":"2590011063","type":"CDM"},{"code":"259","type":"RC"},{"code":"62856024730","type":"NDC"}],"standard_charges":[{"gross_charge":34.73,"discounted_cash":13.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SAXAGLIPTIN 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590011064","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862082630A","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE W/ACETIC ACID S","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011068","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672300701A","type":"NDC"}],"standard_charges":[{"gross_charge":731.62,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"LACOSAMIDE (VIMPAT) 50MG TAB","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590011069","type":"CDM"},{"code":"259","type":"RC"},{"code":"00131247735A","type":"NDC"}],"standard_charges":[{"gross_charge":24.4,"discounted_cash":9.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSIMIDE 150MG TAB","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590011070","type":"CDM"},{"code":"259","type":"RC"},{"code":"00131247935","type":"NDC"}],"standard_charges":[{"gross_charge":40.2,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILODOSIN 8MG CAP","drug_information":{"unit":"8","type":"ME"},"code_information":[{"code":"2590011071","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023614230A","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILODOSIN 4MG CAP","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2590011072","type":"CDM"},{"code":"259","type":"RC"},{"code":"00023614730A","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":7.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENAZEPRIL 20MG TAB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590011073","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268011115A","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FROVATRIPTAN 2.5 MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2590011074","type":"CDM"},{"code":"259","type":"RC"},{"code":"63481002509A","type":"NDC"}],"standard_charges":[{"gross_charge":126.18,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANSOPRAZOLE 15MG SOLUTAB","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2590011076","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378698188A","type":"NDC"}],"standard_charges":[{"gross_charge":29.99,"discounted_cash":12.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 10 MG TAB","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590011078","type":"CDM"},{"code":"259","type":"RC"},{"code":"50458058010","type":"NDC"}],"standard_charges":[{"gross_charge":38.78,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TICAGRELOR 90MG TABLET","drug_information":{"unit":"90","type":"ME"},"code_information":[{"code":"2590011079","type":"CDM"},{"code":"259","type":"RC"},{"code":"00186077739","type":"NDC"}],"standard_charges":[{"gross_charge":20.65,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COENZYME Q-1-0 100MG CAPSULE","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590011080","type":"CDM"},{"code":"259","type":"RC"},{"code":"79854007974A","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCD 7.5MG/ACETA 325MG LIQ","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"2590011081","type":"CDM"},{"code":"259","type":"RC"},{"code":"00121231650A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISMUTH SUBSALCYLTE 524MG/30ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"2590011082","type":"CDM"},{"code":"259","type":"RC"},{"code":"37000047508B","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHYL CHLORIDE SPRAY","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011083","type":"CDM"},{"code":"259","type":"RC"},{"code":"00386000102A","type":"NDC"}],"standard_charges":[{"gross_charge":121.55,"discounted_cash":48.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"DICLOFENAC 1% 100GM GEL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011085","type":"CDM"},{"code":"259","type":"RC"},{"code":"00067815202A","type":"NDC"}],"standard_charges":[{"gross_charge":82.54,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"METRONIDAZOLE 1% 60GM GEL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011086","type":"CDM"},{"code":"259","type":"RC"},{"code":"00299382060A","type":"NDC"}],"standard_charges":[{"gross_charge":843.06,"discounted_cash":337.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"LIDOCAINE 2% JELLY","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"2590011087","type":"CDM"},{"code":"259","type":"RC"},{"code":"25021067376A","type":"NDC"}],"standard_charges":[{"gross_charge":39.87,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CICLOPIROX GEL 30GM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011090","type":"CDM"},{"code":"259","type":"RC"},{"code":"00574206130A","type":"NDC"}],"standard_charges":[{"gross_charge":382.94,"discounted_cash":153.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"CICLOPIROX SHAMPOO 120ML","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011091","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591215990A","type":"NDC"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"GALANTAMINE ER 16MG CAP","drug_information":{"unit":"16","type":"ME"},"code_information":[{"code":"2590011093","type":"CDM"},{"code":"259","type":"RC"},{"code":"47335083683A","type":"NDC"}],"standard_charges":[{"gross_charge":26.63,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFERAXIROX 500MG TAB","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590011095","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078047015","type":"NDC"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE 1.5MG TAB","drug_information":{"unit":"1.5","type":"ME"},"code_information":[{"code":"2590011096","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180052306A","type":"NDC"}],"standard_charges":[{"gross_charge":91.22,"discounted_cash":36.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE XR 400MG TAB","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2590011097","type":"CDM"},{"code":"259","type":"RC"},{"code":"00310028460","type":"NDC"}],"standard_charges":[{"gross_charge":82.68,"discounted_cash":33.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE 15MG TAB","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2590011099","type":"CDM"},{"code":"259","type":"RC"},{"code":"59148000913A","type":"NDC"}],"standard_charges":[{"gross_charge":95.35,"discounted_cash":38.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 1% OPTH SOLUTION","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011100","type":"CDM"},{"code":"259","type":"RC"},{"code":"82584030703A","type":"NDC"}],"standard_charges":[{"gross_charge":443.35,"discounted_cash":177.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"NEBIVOLOL 10MG TAB","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590011101","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687065221A","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FESOTERODINE FUMARATE 4MG TAB","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"2590011102","type":"CDM"},{"code":"259","type":"RC"},{"code":"00069024230A","type":"NDC"}],"standard_charges":[{"gross_charge":19.68,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILDENAFIL 20MG","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590011103","type":"CDM"},{"code":"259","type":"RC"},{"code":"00069419068A","type":"NDC"}],"standard_charges":[{"gross_charge":89.8,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLVAPTAN 15MG TAB","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"2590011104","type":"CDM"},{"code":"259","type":"RC"},{"code":"49884076854A","type":"NDC"}],"standard_charges":[{"gross_charge":2347.18,"discounted_cash":938.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RASAGILINE 1MG TAB","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590011105","type":"CDM"},{"code":"259","type":"RC"},{"code":"68546022956A","type":"NDC"}],"standard_charges":[{"gross_charge":66.93,"discounted_cash":26.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIOTHYRONINE 5MCG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011106","type":"CDM"},{"code":"259","type":"RC"},{"code":"51862032001A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"}]},{"description":"LAMOTRIGINE ER 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590011108","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173075600A","type":"NDC"}],"standard_charges":[{"gross_charge":67.87,"discounted_cash":27.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE 50MG CAP","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590011109","type":"CDM"},{"code":"259","type":"RC"},{"code":"00143314150A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONETASONE 100MCG-Formotorol","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011110","type":"CDM"},{"code":"259","type":"RC"},{"code":"78206012702A","type":"NDC"}],"standard_charges":[{"gross_charge":807.16,"discounted_cash":322.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"MONETASONE 200MCG-FORMOTOROL 5","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011111","type":"CDM"},{"code":"259","type":"RC"},{"code":"78206012602A","type":"NDC"}],"standard_charges":[{"gross_charge":980.87,"discounted_cash":392.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"POLYETHYL/PROPHLENE GLYCOL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011112","type":"CDM"},{"code":"259","type":"RC"},{"code":"00065043133a","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CARB 150MG CAP","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590011113","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054852625","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA 37.5MG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011114","type":"CDM"},{"code":"259","type":"RC"},{"code":"16571069301A","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TAB"}]},{"description":"LURASIDONE 80MG TAB","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"2590011116","type":"CDM"},{"code":"259","type":"RC"},{"code":"63402030830A","type":"NDC"}],"standard_charges":[{"gross_charge":76.41,"discounted_cash":30.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 1.2GM TAB","drug_information":{"unit":"1.2","type":"GM"},"code_information":[{"code":"2590011117","type":"CDM"},{"code":"259","type":"RC"},{"code":"54092047612","type":"NDC"}],"standard_charges":[{"gross_charge":33.6,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE FUMARATE XR 150MG T","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590011119","type":"CDM"},{"code":"259","type":"RC"},{"code":"00310028160A","type":"NDC"}],"standard_charges":[{"gross_charge":47.46,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590011120","type":"CDM"},{"code":"259","type":"RC"},{"code":"00115592201A","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHSCOPOLAMINE 2.5 MG TAB","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"2590011121","type":"CDM"},{"code":"259","type":"RC"},{"code":"76385010001A","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NISOLDIPINE 17MG TAB","drug_information":{"unit":"17","type":"ME"},"code_information":[{"code":"2590011122","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378209701A","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LURASIDONE 40MG TAB","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590011123","type":"CDM"},{"code":"259","type":"RC"},{"code":"63402030430A","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":38.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULOXETINE 60 MG CAP","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"2590011124","type":"CDM"},{"code":"259","type":"RC"},{"code":"68180029606A","type":"NDC"}],"standard_charges":[{"gross_charge":41.43,"discounted_cash":16.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRAHYDROZOLINE/ZINC SULFATE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590011125","type":"CDM"},{"code":"259","type":"RC"},{"code":"11726003701A","type":"NDC"}],"standard_charges":[{"gross_charge":18.32,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"Cariprazine HCL 1.5mg cap","drug_information":{"unit":"1.5","type":"ME"},"code_information":[{"code":"2590011520","type":"CDM"},{"code":"259","type":"RC"},{"code":"61874011520A","type":"NDC"}],"standard_charges":[{"gross_charge":249.1,"discounted_cash":99.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VELTASSA 8.4 PKT","drug_information":{"unit":"8.4","type":"GM"},"code_information":[{"code":"2590011704","type":"CDM"},{"code":"259","type":"RC"},{"code":"53436008430A","type":"NDC"}],"standard_charges":[{"gross_charge":142.39,"discounted_cash":56.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORTIOXETINE 5MG TAB","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"2590011714","type":"CDM"},{"code":"259","type":"RC"},{"code":"64764072030A","type":"NDC"}],"standard_charges":[{"gross_charge":68.3,"discounted_cash":27.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Creon-6 capsule","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590012061","type":"CDM"},{"code":"259","type":"RC"},{"code":"00032004670A","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAP"}]},{"description":"LOVASTATIN 10MG TAB","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590012486","type":"CDM"},{"code":"259","type":"RC"},{"code":"68001031400A","type":"NDC"}],"standard_charges":[{"gross_charge":12.73,"discounted_cash":5.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL (HALF TAB) 25MG","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590012491","type":"CDM"},{"code":"259","type":"RC"},{"code":"72888016230A","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE FUROATE-VILANTEROL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590012492","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173088214A","type":"NDC"}],"standard_charges":[{"gross_charge":619.33,"discounted_cash":247.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"GLYCOPYRROLATE 1MG TAB","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"2590012493","type":"CDM"},{"code":"259","type":"RC"},{"code":"69315013901A","type":"NDC"}],"standard_charges":[{"gross_charge":19.17,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 250MG/5ML LIQ","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590012495","type":"CDM"},{"code":"259","type":"RC"},{"code":"00409433201B","type":"NDC"}],"standard_charges":[{"gross_charge":16.72,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 1TSP","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590012496","type":"CDM"},{"code":"259","type":"RC"},{"code":"51927108800A","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TSP"}]},{"description":"CYANOCOBALAMIN 1,000MCG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590012497","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268085515A","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"BENZOCAINE/RESORCINOL VAG CR","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590012498","type":"CDM"},{"code":"259","type":"RC"},{"code":"11509000372A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"VERAPAMIL ER 24HR 120MG CAP","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"2590012499","type":"CDM"},{"code":"259","type":"RC"},{"code":"00378632001A","type":"NDC"}],"standard_charges":[{"gross_charge":9.21,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOCYCLINE 50MG CAP","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590012501","type":"CDM"},{"code":"259","type":"RC"},{"code":"00591569401A","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESIPRAMINE 25MG TAB","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590012502","type":"CDM"},{"code":"259","type":"RC"},{"code":"45963034202A","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEPRAZOLE 20MG TAB","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"2590012504","type":"CDM"},{"code":"259","type":"RC"},{"code":"60505006502A","type":"NDC"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40MG TAB","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"2590012505","type":"CDM"},{"code":"259","type":"RC"},{"code":"00008084181B","type":"NDC"}],"standard_charges":[{"gross_charge":24.13,"discounted_cash":9.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL (HALF TAB) 12.5MG","drug_information":{"unit":"12.5","type":"ME"},"code_information":[{"code":"2590012512","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862006299A","type":"NDC"}],"standard_charges":[{"gross_charge":6.69,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITAGLIPTIN PHOS 25MG TAB","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590012513","type":"CDM"},{"code":"259","type":"RC"},{"code":"00006022154A","type":"NDC"}],"standard_charges":[{"gross_charge":39.77,"discounted_cash":15.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERLOTINIB 150MG TAB","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"2590012515","type":"CDM"},{"code":"259","type":"RC"},{"code":"62332056730A","type":"NDC"}],"standard_charges":[{"gross_charge":1378.73,"discounted_cash":551.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-370 50ML BTL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"2590013000","type":"CDM"},{"code":"259","type":"RC"},{"code":"00270131630A","type":"NDC"}],"standard_charges":[{"gross_charge":279.08,"discounted_cash":111.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cariprazine HCL 3mg cap","drug_information":{"unit":"3","type":"ME"},"code_information":[{"code":"2590013020","type":"CDM"},{"code":"259","type":"RC"},{"code":"61874013020B","type":"NDC"}],"standard_charges":[{"gross_charge":249.1,"discounted_cash":99.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID 2% OTIC SOL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590013079","type":"CDM"},{"code":"259","type":"RC"},{"code":"52817081615A","type":"NDC"}],"standard_charges":[{"gross_charge":192.17,"discounted_cash":76.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"Itraconazole 100mg/10ml liq","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"2590013284","type":"CDM"},{"code":"259","type":"RC"},{"code":"31722000631A","type":"NDC"}],"standard_charges":[{"gross_charge":117.12,"discounted_cash":46.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Pramipexole 0.5mg tab","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590013286","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687058121A","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"L-Carnitine 500mg cap","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"2590013353","type":"CDM"},{"code":"259","type":"RC"},{"code":"11917013353A","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITONAVIR 100MG TAB","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"2590013811","type":"CDM"},{"code":"259","type":"RC"},{"code":"00054040713A","type":"NDC"}],"standard_charges":[{"gross_charge":46.31,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOVAQUONE 750MG/5ML LIQ","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"2590018276","type":"CDM"},{"code":"259","type":"RC"},{"code":"50268008612A","type":"NDC"}],"standard_charges":[{"gross_charge":238.83,"discounted_cash":95.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIMEGEPANT 75MG ODT","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"2590018277","type":"CDM"},{"code":"259","type":"RC"},{"code":"72618300002A","type":"NDC"}],"standard_charges":[{"gross_charge":504.29,"discounted_cash":201.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Roflumilast 250 mcg tab","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590020124","type":"CDM"},{"code":"259","type":"RC"},{"code":"72205020124A","type":"NDC"}],"standard_charges":[{"gross_charge":66.99,"discounted_cash":26.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"TOLNAFTATE 1% CREAM","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590022102","type":"CDM"},{"code":"259","type":"RC"},{"code":"51672202001A","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"Dolutegravir/Rilpivirine 50-25","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590022710","type":"CDM"},{"code":"259","type":"RC"},{"code":"49702024213B","type":"NDC"}],"standard_charges":[{"gross_charge":567.24,"discounted_cash":226.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Levomefolate Calc 7.5mg tab","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"2590022755","type":"CDM"},{"code":"259","type":"RC"},{"code":"69206011030A","type":"NDC"}],"standard_charges":[{"gross_charge":15.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC CITRATE 210MG TAB","drug_information":{"unit":"210","type":"ME"},"code_information":[{"code":"2590030450","type":"CDM"},{"code":"259","type":"RC"},{"code":"59922063101A","type":"NDC"}],"standard_charges":[{"gross_charge":63.67,"discounted_cash":25.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 24HR 400MG TAB","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"2590042858","type":"CDM"},{"code":"259","type":"RC"},{"code":"42858070101A","type":"NDC"}],"standard_charges":[{"gross_charge":8.11,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Sodium/Pot/Mag 354 bottle","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590042919","type":"CDM"},{"code":"259","type":"RC"},{"code":"10572001201A","type":"NDC"}],"standard_charges":[{"gross_charge":450.65,"discounted_cash":180.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHACRYNIC ACID 15MG TAB","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"2590051116","type":"CDM"},{"code":"259","type":"RC"},{"code":"42799040501A","type":"NDC"}],"standard_charges":[{"gross_charge":114.61,"discounted_cash":45.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cholecalciferol Vit D3 drops","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"2590055005","type":"CDM"},{"code":"259","type":"RC"},{"code":"40093010532A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Paliperidone 6mg ER tab","drug_information":{"unit":"6","type":"ME"},"code_information":[{"code":"2590070170","type":"CDM"},{"code":"259","type":"RC"},{"code":"72819015903A","type":"NDC"}],"standard_charges":[{"gross_charge":145.06,"discounted_cash":58.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Eltrombopag 50mg tab","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590070171","type":"CDM"},{"code":"259","type":"RC"},{"code":"00078068655A","type":"NDC"}],"standard_charges":[{"gross_charge":1513.0,"discounted_cash":605.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Buprenorphine 5mcg patch","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590075040","type":"CDM"},{"code":"259","type":"RC"},{"code":"42858075040A","type":"NDC"}],"standard_charges":[{"gross_charge":291.24,"discounted_cash":116.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"}]},{"description":"Entecavir 0.5mg tab","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"2590083330","type":"CDM"},{"code":"259","type":"RC"},{"code":"31722083330A","type":"NDC"}],"standard_charges":[{"gross_charge":200.83,"discounted_cash":80.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Levetiracetam ER 750 MG TAB","drug_information":{"unit":"750","type":"ME"},"code_information":[{"code":"2590083331","type":"CDM"},{"code":"259","type":"RC"},{"code":"71205088130A","type":"NDC"}],"standard_charges":[{"gross_charge":28.76,"discounted_cash":11.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Sotagliflozin 200mg tab","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"2590083332","type":"CDM"},{"code":"259","type":"RC"},{"code":"70183022131A","type":"NDC"}],"standard_charges":[{"gross_charge":106.06,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Bupr/Nalox 2mg/0.5mg film","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590083333","type":"CDM"},{"code":"259","type":"RC"},{"code":"47781035503A","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Buprenorphine 2mg SL tab","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"2590083334","type":"CDM"},{"code":"259","type":"RC"},{"code":"60687048121A","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Buprenorphine 150mcg film","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590083335","type":"CDM"},{"code":"259","type":"RC"},{"code":"59385002260A","type":"NDC"}],"standard_charges":[{"gross_charge":36.86,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"}]},{"description":"Malarone 250mg-100mg TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590083336","type":"CDM"},{"code":"259","type":"RC"},{"code":"68462040467A","type":"NDC"}],"standard_charges":[{"gross_charge":30.79,"discounted_cash":12.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Clomiphene 50mg tab","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"2590083337","type":"CDM"},{"code":"259","type":"RC"},{"code":"00713088509A","type":"NDC"}],"standard_charges":[{"gross_charge":40.61,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Zenpep 20000u cap","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590083338","type":"CDM"},{"code":"259","type":"RC"},{"code":"73562011201F","type":"NDC"}],"standard_charges":[{"gross_charge":32.84,"discounted_cash":13.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Zenpep 40000u cap","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2590083339","type":"CDM"},{"code":"259","type":"RC"},{"code":"73562011401B","type":"NDC"}],"standard_charges":[{"gross_charge":64.82,"discounted_cash":25.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ambrisentan 10mg tab","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"2590083340","type":"CDM"},{"code":"259","type":"RC"},{"code":"70710118003A","type":"NDC"}],"standard_charges":[{"gross_charge":1194.75,"discounted_cash":477.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Delivery Assist (Rt) Units","code_information":[{"code":"2596285","type":"CDM"},{"code":"419","type":"RC"},{"code":"99464","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiopulmonary Resuscitation Units","code_information":[{"code":"2596332","type":"CDM"},{"code":"480","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":376.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Slp Evaluation Of Speech Fluency Units","code_information":[{"code":"2597750","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Eval Of Speech Sound Prod Units","code_information":[{"code":"2597752","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":132.8,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Eval Lang Comprehension,Express Unit","code_information":[{"code":"2597754","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Behavioral, Qualitative Analysis Units","code_information":[{"code":"2597756","type":"CDM"},{"code":"440","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":139.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Cardiac Echo","code_information":[{"code":"2622297","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2544.0,"discounted_cash":1017.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Initial - Bipap Charge","code_information":[{"code":"2678300","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anasept Gel","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"2690005003","type":"CDM"},{"code":"259","type":"RC"},{"code":"67180050003A","type":"NDC"}],"standard_charges":[{"gross_charge":159.93,"discounted_cash":63.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOLUTION  IV 1/2 NS 500ML","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"2700016868","type":"CDM"},{"code":"258","type":"RC"},{"code":"00338004303A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ea Addt'l Imm < 18 Yrs 90461 - Amb Only Admin Charge","code_information":[{"code":"2702316","type":"CDM"},{"code":"510","type":"RC"},{"code":"90461","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Imm Admin 1St < 18 Yrs 90460 - Amb Only Admin Charge","code_information":[{"code":"2702317","type":"CDM"},{"code":"510","type":"RC"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"SOLUTION  PERIT DIAL 1.5% 2L","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2720088987","type":"CDM"},{"code":"278","type":"RC"},{"code":"00941042452A","type":"NDC"}],"standard_charges":[{"gross_charge":108.05,"discounted_cash":43.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOLUTION  PERIT DIAL 2.5% 2L","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"2720088988","type":"CDM"},{"code":"278","type":"RC"},{"code":"00941043052A","type":"NDC"}],"standard_charges":[{"gross_charge":128.39,"discounted_cash":51.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Fine Needle Aspiration (Fna) W/O Image 10021","code_information":[{"code":"2726314","type":"CDM"},{"code":"510","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.42,"discounted_cash":312.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":468.86,"discounted_cash":187.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":313.0,"discounted_cash":125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Acne Surgery 10040","code_information":[{"code":"2726316","type":"CDM"},{"code":"510","type":"RC"},{"code":"10040","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.31,"discounted_cash":70.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":105.19,"discounted_cash":42.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Drain Skin Abscess,Simple/Sngl 10060","code_information":[{"code":"2726317","type":"CDM"},{"code":"510","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.4,"discounted_cash":182.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":273.24,"discounted_cash":109.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":228.0,"discounted_cash":91.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":455.4,"discounted_cash":182.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Debridement, Muscle/Fascia; 1St 20 Sq Cm 11043","code_information":[{"code":"2726327","type":"CDM"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.03,"discounted_cash":126.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Debridement, Bone; 1St 20 Sq Cm 11044","code_information":[{"code":"2726328","type":"CDM"},{"code":"510","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.16,"discounted_cash":188.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Debridement, Subq Tissue; Each Additional 20 Sq Cm 11045","code_information":[{"code":"2726329","type":"CDM"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.12,"discounted_cash":21.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Trim Skin Lesions, Over 4 11057","code_information":[{"code":"2726333","type":"CDM"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":20.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Zzskin Punch Biopsy 11100","code_information":[{"code":"2726334","type":"CDM"}],"standard_charges":[{"gross_charge":98.14,"discounted_cash":39.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Removal Of Skin Tags (Up To 15)  11200","code_information":[{"code":"2726336","type":"CDM"},{"code":"510","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.22,"discounted_cash":180.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":270.14,"discounted_cash":108.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":450.22,"discounted_cash":180.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Remove Skin Tags Add-On 11201","code_information":[{"code":"2726337","type":"CDM"},{"code":"510","type":"RC"},{"code":"11201","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":33.35,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Shave Epidermal Dermal Lesion Trunk Arms Legs 0.6 Cm  To 1.0 Cm","code_information":[{"code":"2726339","type":"CDM"},{"code":"510","type":"RC"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":267.03,"discounted_cash":106.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":178.0,"discounted_cash":71.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Shave Epidermal Dermal Lesion Face Ears Eyelids Nose Lips Mucous Memb 0.5 Cm Or Less","code_information":[{"code":"2726344","type":"CDM"},{"code":"510","type":"RC"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":35.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Shave Epidermal Dermal Lesion Face Ears Eyelids Nose Lips Mucous Memb 0.6 Cm To 1.0 Cm","code_information":[{"code":"2726345","type":"CDM"},{"code":"510","type":"RC"},{"code":"11311","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.2,"discounted_cash":51.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":76.92,"discounted_cash":30.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":265.19,"discounted_cash":106.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Tr-Ext B9 Plus Marg 2.1-3 Cm 11403","code_information":[{"code":"2726349","type":"CDM"},{"code":"510","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":844.56,"discounted_cash":337.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":563.0,"discounted_cash":225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Tr-Ext B9 Plus Marg 3.1-4 Cm 11404","code_information":[{"code":"2726350","type":"CDM"},{"code":"510","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3260.25,"discounted_cash":1304.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1956.15,"discounted_cash":782.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1304.0,"discounted_cash":521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3260.25,"discounted_cash":1304.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc H-F-Nk-Sp B9 Plus Marg 0.5 Less Than  11420","code_information":[{"code":"2726352","type":"CDM"},{"code":"510","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3275.78,"discounted_cash":1310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1965.46,"discounted_cash":786.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1310.0,"discounted_cash":524.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3275.78,"discounted_cash":1310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc H-F-Nk-Sp B9 Plus Marg 2.1-3 11423","code_information":[{"code":"2726355","type":"CDM"},{"code":"510","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3275.78,"discounted_cash":1310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Face-Mm B9 Plus Marg 0.5 Greater Than  Cm 11440","code_information":[{"code":"2726356","type":"CDM"},{"code":"510","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.42,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":841.46,"discounted_cash":336.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":561.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1402.42,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Face-Mm B9 Plus Marg 0.6-1 Cm 11441","code_information":[{"code":"2726357","type":"CDM"},{"code":"510","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.42,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":841.46,"discounted_cash":336.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":561.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1402.42,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Face-Mm B9 Plus Marg 1.1-2 Cm 11442","code_information":[{"code":"2726358","type":"CDM"},{"code":"510","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.42,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":841.46,"discounted_cash":336.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":561.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1402.42,"discounted_cash":560.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Tr-Ext Mlg Plus Marg 1.1-2 Cm 11602","code_information":[{"code":"2726359","type":"CDM"},{"code":"510","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.25,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":776.25,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Tr-Ext Mlg Plus Marg 2.1-3 Cm 11603","code_information":[{"code":"2726360","type":"CDM"},{"code":"510","type":"RC"},{"code":"11603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":838.35,"discounted_cash":335.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc H-F-Nk-Sp Mlg Plus Marg 1.1-2 Cm 11622","code_information":[{"code":"2726362","type":"CDM"},{"code":"510","type":"RC"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.87,"discounted_cash":137.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":206.32,"discounted_cash":82.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Exc Face-Mm Malig Plus Marg 0.6-1 11641","code_information":[{"code":"2726364","type":"CDM"},{"code":"361","type":"RC"},{"code":"11641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":600.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Exc Face-Mm Malig Plus Marg 1.1-2 11642","code_information":[{"code":"2726365","type":"CDM"},{"code":"510","type":"RC"},{"code":"11642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":844.56,"discounted_cash":337.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":563.0,"discounted_cash":225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Face-Mm Malig Plus Marg 2.1-3 11643","code_information":[{"code":"2726366","type":"CDM"},{"code":"361","type":"RC"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":3500.0,"discounted_cash":1400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":2100.0,"discounted_cash":840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1400.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Remove Nail Plate, Add-On 11732","code_information":[{"code":"2726371","type":"CDM"},{"code":"510","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.79,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":25.08,"discounted_cash":10.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":41.79,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Biopsy Of Nail Unit","code_information":[{"code":"2726373","type":"CDM"},{"code":"361","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":600.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Wedge Excision Of Skin Of Nail Fold 11765","code_information":[{"code":"2726375","type":"CDM"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.47,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove Drug Implant Device 11982","code_information":[{"code":"2726382","type":"CDM"},{"code":"510","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.88,"discounted_cash":341.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Rep Superfic Wound 2.5Cm Less 12001","code_information":[{"code":"2726383","type":"CDM"},{"code":"510","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":279.45,"discounted_cash":111.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Rep Superfic Wound 2.6-7.5Cm 12002","code_information":[{"code":"2726384","type":"CDM"},{"code":"510","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.58,"discounted_cash":184.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":276.35,"discounted_cash":110.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":460.58,"discounted_cash":184.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Rep Superfic Wounds 2.5Cm Less 12011","code_information":[{"code":"2726385","type":"CDM"},{"code":"510","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":279.45,"discounted_cash":111.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Intermed Rpr, Neck, Hands, Feet, Ext Genital 2.6-7.5Cm 12042","code_information":[{"code":"2726391","type":"CDM"},{"code":"510","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.78,"discounted_cash":316.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":475.06,"discounted_cash":190.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":317.0,"discounted_cash":126.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":791.78,"discounted_cash":316.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Repair Complex Scalp Arms And Or Legs 2.6Cm-7.5Cm","code_information":[{"code":"2726397","type":"CDM"},{"code":"510","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.23,"discounted_cash":214.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":322.34,"discounted_cash":128.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":215.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Cmplx Rpr, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet, 1.1-2.5Cm","code_information":[{"code":"2726399","type":"CDM"},{"code":"510","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.18,"discounted_cash":201.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":301.91,"discounted_cash":120.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Cmplx Rpr, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet, 2.6Cm ? 7.5Cm","code_information":[{"code":"2726400","type":"CDM"},{"code":"510","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.72,"discounted_cash":469.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":704.84,"discounted_cash":281.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1174.72,"discounted_cash":469.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Cmplx Rpr, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet, Each Additional 5Cm","code_information":[{"code":"2726401","type":"CDM"},{"code":"510","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.39,"discounted_cash":106.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":159.24,"discounted_cash":63.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":265.39,"discounted_cash":106.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Cmplx Rpr, Eyelid/Nose/Ears/Lips 1.1-2.5Cm 13151","code_information":[{"code":"2726402","type":"CDM"},{"code":"510","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.61,"discounted_cash":231.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":346.57,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":231.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Cmplx Rpr, Eyelids/Nose/Ears/Lips 2.6-7.5Cm  13152","code_information":[{"code":"2726403","type":"CDM"},{"code":"510","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.76,"discounted_cash":279.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":419.86,"discounted_cash":167.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Tis Trnfr F/C/C/M/N/A/G/H/F Less Than Or Equal Too Sqcm 14040","code_information":[{"code":"2726407","type":"CDM"},{"code":"510","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.26,"discounted_cash":506.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":759.76,"discounted_cash":303.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":582.0,"discounted_cash":232.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Tis Trnfr F/C/M/N/A/G/H/F 10.1-30 Sqcm 14041","code_information":[{"code":"2726408","type":"CDM"},{"code":"510","type":"RC"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":1557.3,"discounted_cash":622.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":934.38,"discounted_cash":373.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":716.0,"discounted_cash":286.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Skin Tiss Rearrnge,10Sq Cm Less 14060","code_information":[{"code":"2726409","type":"CDM"},{"code":"510","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1348.73,"discounted_cash":539.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":809.24,"discounted_cash":323.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":620.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Skin Tissue Rearrangement 14301","code_information":[{"code":"2726411","type":"CDM"},{"code":"510","type":"RC"},{"code":"14301","type":"HCPCS"}],"standard_charges":[{"gross_charge":7500.0,"discounted_cash":3000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":4500.0,"discounted_cash":1800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":3450.0,"discounted_cash":1380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Skin Split Graft 1St 100Sq Cm 15100","code_information":[{"code":"2726415","type":"CDM"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.98,"discounted_cash":572.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Relocation Of Skin To Nose, Ears, Eyelids, Ao Lips 20 Sqcm Or Less","code_information":[{"code":"2726418","type":"CDM"},{"code":"361","type":"RC"},{"code":"15260","type":"HCPCS"}],"standard_charges":[{"gross_charge":4000.0,"discounted_cash":1600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":2400.0,"discounted_cash":960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1840.0,"discounted_cash":736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Blepharoplasty, Upper Eyelid W/Excess Skin Weighting Down Lid 15823","code_information":[{"code":"2726429","type":"CDM"},{"code":"15823","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.89,"discounted_cash":432.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Destruct Bengn Les 1-14 17110","code_information":[{"code":"2726438","type":"CDM"},{"code":"510","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.4,"discounted_cash":182.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":273.24,"discounted_cash":109.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":455.4,"discounted_cash":182.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Destruct Bengn Les >=15 17111","code_information":[{"code":"2726439","type":"CDM"},{"code":"510","type":"RC"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.57,"discounted_cash":67.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":101.74,"discounted_cash":40.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Malignant Destruction Less 0.5Cm 17260","code_information":[{"code":"2726441","type":"CDM"},{"code":"510","type":"RC"},{"code":"17260","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct, Malig Lesion, Trunk, Diam 0.6 To 1.0 Cm","code_information":[{"code":"2726442","type":"CDM"},{"code":"510","type":"RC"},{"code":"17261","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct., Malig Lesion, Trunk, Diam 1.1 To 2.0 Cmr","code_information":[{"code":"2726443","type":"CDM"},{"code":"510","type":"RC"},{"code":"17262","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":282.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct., Malig Lesion, Scalp, Diam 0.5 Cm Or Less","code_information":[{"code":"2726444","type":"CDM"},{"code":"510","type":"RC"},{"code":"17270","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":282.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct., Malig Lesion, Scalp, Diam 0.6 To 1.0 Cm","code_information":[{"code":"2726445","type":"CDM"},{"code":"510","type":"RC"},{"code":"17271","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruction Malignant Lesion Scalp/Neck/Hnd/Ft/Genit 1.1-2Cm","code_information":[{"code":"2726446","type":"CDM"},{"code":"510","type":"RC"},{"code":"17272","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":215.36,"discounted_cash":86.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct., Malig Lesion, Face, Diam 0.5 Cm Or Less","code_information":[{"code":"2726447","type":"CDM"},{"code":"510","type":"RC"},{"code":"17280","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":282.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruction Malignant Lesion Face/Ear/Eyelid/Nose/Lip/Muc Membr 0.6-1Cm","code_information":[{"code":"2726448","type":"CDM"},{"code":"510","type":"RC"},{"code":"17281","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruction Malignant Lesion Face/Ear/Eyelid/Nose/Lip/Muc Membr 1.1-2Cm","code_information":[{"code":"2726449","type":"CDM"},{"code":"510","type":"RC"},{"code":"17282","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Mohs 1St Stage Head/Neck/Hnd/Ft/Genital Lt Or Eq To 5 Tissue Blocks","code_information":[{"code":"2726450","type":"CDM"},{"code":"510","type":"RC"},{"code":"17311","type":"HCPCS"}],"standard_charges":[{"gross_charge":1274.84,"discounted_cash":509.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":764.9,"discounted_cash":305.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":510.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Mohs Each Addtl Stage Head/Neck/Hnd/Ft/Genital Lt Or Eq To 5 Tissue Blocks","code_information":[{"code":"2726451","type":"CDM"},{"code":"510","type":"RC"},{"code":"17312","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.41,"discounted_cash":309.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":464.65,"discounted_cash":185.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Mohs 1St Stage Trunk/Arm/Leg Lt Or Eq To 5 Tissue Blocks","code_information":[{"code":"2726452","type":"CDM"},{"code":"510","type":"RC"},{"code":"17313","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.26,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":717.76,"discounted_cash":287.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":478.0,"discounted_cash":191.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Mohs Each Addtl Stage Trunk/Arm/Leg Lt Or Eq To 5 Tissue Blocks","code_information":[{"code":"2726453","type":"CDM"},{"code":"510","type":"RC"},{"code":"17314","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.73,"discounted_cash":296.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":444.44,"discounted_cash":177.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":444.44,"discounted_cash":177.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Excision Subcutaneous Tumor Soft Tissue Face Or Scalp Less Than 2 Cm","code_information":[{"code":"2726493","type":"CDM"},{"code":"361","type":"RC"},{"code":"21011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3400.0,"discounted_cash":1360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":2400.0,"discounted_cash":960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1360.0,"discounted_cash":544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Biopsy, Soft Tissue Of Neck Or Thorax 21550","code_information":[{"code":"2726497","type":"CDM"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.1,"discounted_cash":126.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Subcutaneous Tumor Soft Tissue Neck Ant Thorax Less Than 3 Cm","code_information":[{"code":"2726498","type":"CDM"},{"code":"510","type":"RC"},{"code":"21555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3275.78,"discounted_cash":1310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1965.46,"discounted_cash":786.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1310.0,"discounted_cash":524.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3275.78,"discounted_cash":1310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Closed Treatment Of Radial Head Subluxation","code_information":[{"code":"2726541","type":"CDM"},{"code":"510","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.25,"discounted_cash":227.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":341.55,"discounted_cash":136.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":228.0,"discounted_cash":91.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":569.25,"discounted_cash":227.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Application Of Rigid Total Leg Cast 29445","code_information":[{"code":"2726674","type":"CDM"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.29,"discounted_cash":85.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Application Of Paste Boot 29580","code_information":[{"code":"2726677","type":"CDM"},{"code":"510","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.42,"discounted_cash":146.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":220.46,"discounted_cash":88.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":367.42,"discounted_cash":146.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Septoplasty W/Wo Repl/Gft 30520","code_information":[{"code":"2726711","type":"CDM"},{"code":"30520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.93,"discounted_cash":494.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ctrl Nsebld Ant Smpl/Ltd 30901","code_information":[{"code":"2726713","type":"CDM"},{"code":"510","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.62,"discounted_cash":113.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":170.78,"discounted_cash":68.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":114.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":284.62,"discounted_cash":113.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Ctrl Nsebld Ant Cmplx/Ext 30903","code_information":[{"code":"2726714","type":"CDM"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.38,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ctrl Nosebld Postir Initl 30905","code_information":[{"code":"2726715","type":"CDM"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.87,"discounted_cash":81.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Endscp Ethmoidectmy Totl 31255","code_information":[{"code":"2726723","type":"CDM"},{"code":"31255","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.27,"discounted_cash":372.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Nsl Endscpysurg Plus Maxilantr 31256","code_information":[{"code":"2726724","type":"CDM"},{"code":"31256","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.85,"discounted_cash":160.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tracheotomy Tube Change Prior To Establishment Of Fistula Tract 31502","code_information":[{"code":"2726730","type":"CDM"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.06,"discounted_cash":28.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Diagnostic Laryngoscopy 31575","code_information":[{"code":"2726733","type":"CDM"},{"code":"510","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.12,"discounted_cash":155.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":232.88,"discounted_cash":93.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":388.12,"discounted_cash":155.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Insert Pleural Cath 32550","code_information":[{"code":"2726754","type":"CDM"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.52,"discounted_cash":182.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insert Chest Tube 32551","code_information":[{"code":"2726755","type":"CDM"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.9,"discounted_cash":139.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insert New Or Replace Pacemaker And Leads Dual Lead 33208","code_information":[{"code":"2726761","type":"CDM"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":429.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insertion Of Temporary Pacemaker, Single Lead 33210","code_information":[{"code":"2726762","type":"CDM"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.12,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":363.12,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Insert Single Lead, Pacemaker Or Icd 33216","code_information":[{"code":"2726764","type":"CDM"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.21,"discounted_cash":307.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insert Dual Leads, Pacemaker Or Icd 33217","code_information":[{"code":"2726765","type":"CDM"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.76,"discounted_cash":301.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove & Replace Dual Lead Pacemaker Generator Only 33228","code_information":[{"code":"2726770","type":"CDM"},{"code":"510","type":"RC"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.55,"discounted_cash":293.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove Pacemaker Generator Only 33233","code_information":[{"code":"2726771","type":"CDM"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.97,"discounted_cash":194.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove Icd Generator Only 33241","code_information":[{"code":"2726773","type":"CDM"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.79,"discounted_cash":183.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Intra-Aortic Balloon Pump (Iabp) Insertion, Percutaneous 33967","code_information":[{"code":"2726803","type":"CDM"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.22,"discounted_cash":264.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":661.22,"discounted_cash":264.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Injection For Extremity Venography 36005","code_information":[{"code":"2726817","type":"CDM"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.67,"discounted_cash":39.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Selective Cath Placement; 1St Ord Thoracic Or Brachiceph Art Branch 36215","code_information":[{"code":"2726821","type":"CDM"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.11,"discounted_cash":194.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insertion Of Venous Access Device, 5 Yrs Or Older 36556","code_information":[{"code":"2726835","type":"CDM"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.39,"discounted_cash":99.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Arterial Blood Draw, Therapeutic (Ie,Transfusion), Percutaneous 36620","code_information":[{"code":"2726842","type":"CDM"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.78,"discounted_cash":42.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Biopsy/Excision Lymph Nodes-Open-Deep-Cervical 38510","code_information":[{"code":"2726866","type":"CDM"},{"code":"510","type":"RC"},{"code":"38510","type":"HCPCS"}],"standard_charges":[{"gross_charge":6655.05,"discounted_cash":2662.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3993.03,"discounted_cash":1597.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":2662.0,"discounted_cash":1064.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":6655.05,"discounted_cash":2662.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Radical Modified Neck Dissection Cervical Lymphadenectomy 38724","code_information":[{"code":"2726870","type":"CDM"},{"code":"38724","type":"HCPCS"}],"standard_charges":[{"gross_charge":2951.55,"discounted_cash":1180.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Biopsy Of Lip 40490","code_information":[{"code":"2726878","type":"CDM"},{"code":"510","type":"RC"},{"code":"40490","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.77,"discounted_cash":59.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":89.26,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Uppp, Palatophayringoplasty/Uvulopalatopharyngoplasty 42145","code_information":[{"code":"2726880","type":"CDM"},{"code":"42145","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.38,"discounted_cash":572.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Removal Tonsils And Adenoids, Younger Than Age 12 42820","code_information":[{"code":"2726881","type":"CDM"},{"code":"42820","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.36,"discounted_cash":235.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Removal Tonsils And Adenoids, Age 12 Or Over 42821","code_information":[{"code":"2726882","type":"CDM"},{"code":"42821","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.69,"discounted_cash":244.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tonsillectomy, Primary Or Secondary, Younger Than Age 12 42825","code_information":[{"code":"2726883","type":"CDM"},{"code":"42825","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.71,"discounted_cash":211.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tonsillectomy, Primary Or Secondary, Age 12 Or Over 42826","code_information":[{"code":"2726884","type":"CDM"},{"code":"42826","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.95,"discounted_cash":203.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Adenoidectomy, Primary, Younger Than Age 12 42830","code_information":[{"code":"2726885","type":"CDM"},{"code":"42830","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.15,"discounted_cash":168.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Adenoidectomy, Primary, Age 12 Or Over 42831","code_information":[{"code":"2726886","type":"CDM"},{"code":"42831","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.28,"discounted_cash":180.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, Dx (Upper Gi) 43235","code_information":[{"code":"2726887","type":"CDM"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.26,"discounted_cash":156.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Directed Submucosal Injection (Upper Gi) 43236","code_information":[{"code":"2726888","type":"CDM"},{"code":"43236","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.72,"discounted_cash":121.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Upper Gi Endoscopy, Biopsy 43239","code_information":[{"code":"2726889","type":"CDM"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":334.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Us Guided Fine Needle Biopsy/Aspiration 43242","code_information":[{"code":"2726890","type":"CDM"},{"code":"43242","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.59,"discounted_cash":227.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Percutaneous Gastrostomy Tube (Upper Gi) 43246","code_information":[{"code":"2726891","type":"CDM"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.01,"discounted_cash":231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Foreign Body Removal (Upper Gi) 43247","code_information":[{"code":"2726892","type":"CDM"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.55,"discounted_cash":153.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Guide Wire / Dilator (Upper Gi) 43248","code_information":[{"code":"2726893","type":"CDM"},{"code":"43248","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.94,"discounted_cash":144.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Removal Lesion By Snare (Upper Gi) 43251","code_information":[{"code":"2726895","type":"CDM"},{"code":"43251","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.61,"discounted_cash":195.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Control Of Bleeding 43255","code_information":[{"code":"2726896","type":"CDM"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.33,"discounted_cash":278.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Upper Gi Endoscopy, Flexible Transoral, W/ Endoscopic Ultrasound 43259","code_information":[{"code":"2726899","type":"CDM"},{"code":"43259","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.5,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp W/ Biopsy,Single/Multiple 43261","code_information":[{"code":"2726900","type":"CDM"},{"code":"43261","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.37,"discounted_cash":290.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp With Sphincterotomy Or Papillotomy 43262","code_information":[{"code":"2726901","type":"CDM"},{"code":"43262","type":"HCPCS"}],"standard_charges":[{"gross_charge":971.24,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp With Removal Calculi/Debris From Biliary/Pancreatic Duct(S) 43264","code_information":[{"code":"2726902","type":"CDM"},{"code":"43264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1055.18,"discounted_cash":422.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp With Destruction Of Calculi 43265","code_information":[{"code":"2726903","type":"CDM"},{"code":"43265","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.87,"discounted_cash":370.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laparoscopic Repair Paraesophageal Hernia, W/O Mesh, Fundoplasty Incld 43281","code_information":[{"code":"2726909","type":"CDM"},{"code":"43281","type":"HCPCS"}],"standard_charges":[{"gross_charge":3118.58,"discounted_cash":1247.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3171.32,"discounted_cash":1268.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Dilate Esophagus, Unguided Sound Or Bougie, Single Or Multiple Passes 43450","code_information":[{"code":"2726911","type":"CDM"},{"code":"43450","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.27,"discounted_cash":71.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Freeing Of Bowel Adhesion 44005","code_information":[{"code":"2726914","type":"CDM"},{"code":"44005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.79,"discounted_cash":882.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laparascopic Cholecystectomy 47562","code_information":[{"code":"2726953","type":"CDM"},{"code":"47562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.67,"discounted_cash":528.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insert Non-Indwelling Bladder Cath 51701","code_information":[{"code":"2726984","type":"CDM"},{"code":"510","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.8,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":173.88,"discounted_cash":69.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":289.8,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Pvr/Bladder Capacity Measurement-Ultrasound 51798","code_information":[{"code":"2726994","type":"CDM"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.81,"discounted_cash":14.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Destruction Of Penis Lesion, Simple","code_information":[{"code":"2727011","type":"CDM"},{"code":"510","type":"RC"},{"code":"54056","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":279.45,"discounted_cash":111.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Circumcision,Clamp/Oth Device 54150","code_information":[{"code":"2727012","type":"CDM"},{"code":"510","type":"RC"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.69,"discounted_cash":79.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"I & D Of Vulva/Perineum","code_information":[{"code":"2727023","type":"CDM"},{"code":"510","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.19,"discounted_cash":160.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":118.63,"discounted_cash":47.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":283.0,"discounted_cash":113.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Anterior Colporrhaphy, Repair Of Cystocele W/Wo Repair Of Urethrocele 57240","code_information":[{"code":"2727027","type":"CDM"},{"code":"57240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.16,"discounted_cash":540.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Posterior Colporrhaphy, Repair Of Rectocele W/Wo Perineorrhaphy 57250","code_information":[{"code":"2727028","type":"CDM"},{"code":"57250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1359.2,"discounted_cash":543.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Colpopexy, Vag Intra-Peritoneal Approach Uterosacral 57283","code_information":[{"code":"2727032","type":"CDM"},{"code":"57283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.77,"discounted_cash":553.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Sling Operation Stress Incontinence (Eg, Fascia/Synthetic) 57288","code_information":[{"code":"2727033","type":"CDM"},{"code":"57288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.51,"discounted_cash":576.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Bx/Curettage Of Cervix W/Scope 57454","code_information":[{"code":"2727037","type":"CDM"},{"code":"510","type":"RC"},{"code":"57454","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.75,"discounted_cash":269.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":403.65,"discounted_cash":161.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":672.75,"discounted_cash":269.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Endocerv Curettage W/Scope 57456","code_information":[{"code":"2727039","type":"CDM"},{"code":"57456","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.72,"discounted_cash":83.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Biopsy Cervix,Single/Multiple 57500","code_information":[{"code":"2727041","type":"CDM"},{"code":"510","type":"RC"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.5,"discounted_cash":538.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":807.3,"discounted_cash":322.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":538.0,"discounted_cash":215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":152.72,"discounted_cash":61.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Conization Cervix, W/Wo Repair Loop Electrode Excision 57522","code_information":[{"code":"2727044","type":"CDM"},{"code":"510","type":"RC"},{"code":"57522","type":"HCPCS"}],"standard_charges":[{"gross_charge":5589.0,"discounted_cash":2235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3353.4,"discounted_cash":1341.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":2236.0,"discounted_cash":894.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":5589.0,"discounted_cash":2235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"D&C, Diagnostic And/Or Therapeutic Nonobstetrical 58120","code_information":[{"code":"2727046","type":"CDM"},{"code":"58120","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.14,"discounted_cash":176.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tah Corpus & Cervix W/Wo Rmvl Of Tube(S) W/Wo Rmvl Of Ovary(S) 58150","code_information":[{"code":"2727047","type":"CDM"},{"code":"58150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2036.8,"discounted_cash":814.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cath & Intro Of Saline/Contrast Sonohystero/Hysterosalpingography 58340","code_information":[{"code":"2727054","type":"CDM"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.91,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Endometrial Ablation Thermal W/O Hysteroscopic Guide 58353","code_information":[{"code":"2727055","type":"CDM"},{"code":"58353","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.44,"discounted_cash":175.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laparoscopy Surgical, W/Vaginal Hysterectomy Uterus 250 G Less; 58550","code_information":[{"code":"2727057","type":"CDM"},{"code":"58550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.9,"discounted_cash":708.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laparo-Vag Hyst Incl T/O 58552","code_information":[{"code":"2727058","type":"CDM"},{"code":"58552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1985.21,"discounted_cash":794.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Hysteroscopy,Ablation 58563","code_information":[{"code":"2727060","type":"CDM"},{"code":"58563","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.94,"discounted_cash":275.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ligate Oviduct(S) Add-On 58611","code_information":[{"code":"2727064","type":"CDM"},{"code":"58611","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.88,"discounted_cash":93.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laparoscopy,Remove Adnexa 58661","code_information":[{"code":"2727065","type":"CDM"},{"code":"58661","type":"HCPCS"}],"standard_charges":[{"gross_charge":1304.8,"discounted_cash":521.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laparoscopy,Excise Lesions 58662","code_information":[{"code":"2727066","type":"CDM"},{"code":"58662","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.15,"discounted_cash":570.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laparoscopy,Tubal Cautery 58670","code_information":[{"code":"2727067","type":"CDM"},{"code":"58670","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.65,"discounted_cash":291.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Obstetrical Care 59400","code_information":[{"code":"2727071","type":"CDM"},{"code":"59400","type":"HCPCS"}],"standard_charges":[{"gross_charge":4201.87,"discounted_cash":1680.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Obstetrical Care  59409","code_information":[{"code":"2727072","type":"CDM"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":1651.69,"discounted_cash":660.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Obstetrical Care   59410","code_information":[{"code":"2727073","type":"CDM"},{"code":"59410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2105.79,"discounted_cash":842.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Antepartum Care Only,4-6 Visits 59425","code_information":[{"code":"2727074","type":"CDM"},{"code":"510","type":"RC"},{"code":"59425","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.51,"discounted_cash":289.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":434.1,"discounted_cash":173.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":289.0,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":723.51,"discounted_cash":289.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Antepartum Care Only,7 Plus  Visits 59426","code_information":[{"code":"2727075","type":"CDM"},{"code":"59426","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.2,"discounted_cash":510.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Total Ob Care;Cesarean Delivery 59510","code_information":[{"code":"2727077","type":"CDM"},{"code":"59510","type":"HCPCS"}],"standard_charges":[{"gross_charge":4639.74,"discounted_cash":1855.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cesarean Section Delivery Only 59514","code_information":[{"code":"2727078","type":"CDM"},{"code":"59514","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.66,"discounted_cash":741.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1854.66,"discounted_cash":741.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"C-Section Delivery Incl P/P Care 59515","code_information":[{"code":"2727079","type":"CDM"},{"code":"59515","type":"HCPCS"}],"standard_charges":[{"gross_charge":2544.69,"discounted_cash":1017.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Treatment Of Miscarriage 59812","code_information":[{"code":"2727081","type":"CDM"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.74,"discounted_cash":237.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Partial Removal Of Thyroid 60220","code_information":[{"code":"2727085","type":"CDM"},{"code":"60220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.96,"discounted_cash":570.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Scan Proc Cranial Extra 61782","code_information":[{"code":"2727094","type":"CDM"},{"code":"61782","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.46,"discounted_cash":143.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Chemodenerv Musc Migraine 64615","code_information":[{"code":"2727134","type":"CDM"},{"code":"510","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":375.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Repair Of Brow Ptosis 67900","code_information":[{"code":"2727153","type":"CDM"},{"code":"67900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.51,"discounted_cash":405.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Biopsy External Ear 69100","code_information":[{"code":"2727162","type":"CDM"},{"code":"510","type":"RC"},{"code":"69100","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.67,"discounted_cash":209.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":313.6,"discounted_cash":125.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":522.67,"discounted_cash":209.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Remove Impacted Ear Wax 69210","code_information":[{"code":"2727165","type":"CDM"},{"code":"510","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.47,"discounted_cash":53.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":80.08,"discounted_cash":32.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":133.47,"discounted_cash":53.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Debridement Mastoidectomy Cavity, Simple 69220","code_information":[{"code":"2727166","type":"CDM"},{"code":"510","type":"RC"},{"code":"69220","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.68,"discounted_cash":185.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":278.21,"discounted_cash":111.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":463.68,"discounted_cash":185.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Remove Ventilating Tube W/General Anesthesia 69424","code_information":[{"code":"2727167","type":"CDM"},{"code":"69424","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.39,"discounted_cash":99.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tympanostomy, W Vent Tube, Local/Topical Anesthesia 69433","code_information":[{"code":"2727168","type":"CDM"},{"code":"510","type":"RC"},{"code":"69433","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.25,"discounted_cash":476.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":714.15,"discounted_cash":285.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":595.0,"discounted_cash":238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":476.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."},{"gross_charge":1190.25,"discounted_cash":476.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Tympanostomy W Vent Tube, General Anesthesia 69436","code_information":[{"code":"2727169","type":"CDM"},{"code":"69436","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.67,"discounted_cash":258.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tympanic Membrane Repair 69610","code_information":[{"code":"2727170","type":"CDM"},{"code":"361","type":"RC"},{"code":"69610","type":"HCPCS"}],"standard_charges":[{"gross_charge":3200.0,"discounted_cash":1280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1920.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1472.0,"discounted_cash":588.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Labrinthotomy, W/Perfusion Of Vestibuloactive Drug(S), Transcanal 69801","code_information":[{"code":"2727171","type":"CDM"},{"code":"510","type":"RC"},{"code":"69801","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.72,"discounted_cash":189.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":283.63,"discounted_cash":113.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":217.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3048.08,"discounted_cash":1219.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Facial Bones,Complete 70150","code_information":[{"code":"2727176","type":"CDM"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Nasal Bones 70160","code_information":[{"code":"2727177","type":"CDM"},{"code":"510","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.63,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":44.63,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Sinuses 70210","code_information":[{"code":"2727178","type":"CDM"},{"code":"510","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Chest 2V, Front/Later 71046","code_information":[{"code":"2727193","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.59,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":31.59,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Ribs 71100","code_information":[{"code":"2727196","type":"CDM"},{"code":"510","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":35.62,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Ribs 71110","code_information":[{"code":"2727198","type":"CDM"},{"code":"510","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.02,"discounted_cash":28.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":72.02,"discounted_cash":28.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Neck Spine 4V 72050","code_information":[{"code":"2727206","type":"CDM"},{"code":"510","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.86,"discounted_cash":21.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":53.86,"discounted_cash":21.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Thoracic Spine 72070","code_information":[{"code":"2727209","type":"CDM"},{"code":"510","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.97,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":36.97,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Lower Spine 4V 72110","code_information":[{"code":"2727214","type":"CDM"},{"code":"510","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.27,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":61.27,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Pelvis 72170","code_information":[{"code":"2727223","type":"CDM"},{"code":"510","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Tailbone 72220","code_information":[{"code":"2727227","type":"CDM"},{"code":"510","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Collar Bone 73000","code_information":[{"code":"2727229","type":"CDM"},{"code":"510","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":35.68,"discounted_cash":14.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Shoulders 73050","code_information":[{"code":"2727233","type":"CDM"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.43,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":46.43,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Elbow 73070","code_information":[{"code":"2727235","type":"CDM"},{"code":"510","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":35.62,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Elbow  73080","code_information":[{"code":"2727236","type":"CDM"},{"code":"510","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.91,"discounted_cash":16.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":41.91,"discounted_cash":16.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Forearm 73090","code_information":[{"code":"2727237","type":"CDM"},{"code":"510","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":12.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":32.25,"discounted_cash":12.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Wrist  73110","code_information":[{"code":"2727239","type":"CDM"},{"code":"510","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Hand 73120","code_information":[{"code":"2727240","type":"CDM"},{"code":"510","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.98,"discounted_cash":13.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":32.98,"discounted_cash":13.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Finger(S) 73140","code_information":[{"code":"2727242","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.18,"discounted_cash":18.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":45.18,"discounted_cash":18.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Knee 4 Or More 73564","code_information":[{"code":"2727254","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Ankle  73610","code_information":[{"code":"2727258","type":"CDM"},{"code":"510","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.71,"discounted_cash":16.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":41.71,"discounted_cash":16.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Foot 73620","code_information":[{"code":"2727259","type":"CDM"},{"code":"510","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":19.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":34.33,"discounted_cash":13.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Foot 2V 73630","code_information":[{"code":"2727260","type":"CDM"},{"code":"510","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.34,"discounted_cash":15.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":38.34,"discounted_cash":15.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Abdomen 74018","code_information":[{"code":"2727268","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.85,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":26.85,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Ct Angio Heart W/3D Image 75574","code_information":[{"code":"2727287","type":"CDM"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.67,"discounted_cash":96.67,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":241.67,"discounted_cash":96.67,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Aortograph, Abdomen Plus Iliofemor 75630","code_information":[{"code":"2727290","type":"CDM"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.74,"discounted_cash":71.5,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":178.74,"discounted_cash":71.5,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Artery X-Rays, Arm/Leg 75710","code_information":[{"code":"2727295","type":"CDM"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.37,"discounted_cash":45.75,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":114.37,"discounted_cash":45.75,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob) Less Than 14 Wks, Single Fetus 76801","code_information":[{"code":"2727326","type":"CDM"},{"code":"510","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.98,"discounted_cash":117.99,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":176.98,"discounted_cash":70.79,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":103.71,"discounted_cash":41.48,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob) > 14 Wks, Sngl Fetus 76805","code_information":[{"code":"2727327","type":"CDM"},{"code":"510","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.08,"discounted_cash":111.63,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":167.45,"discounted_cash":66.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":103.69,"discounted_cash":41.48,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob) > 14 Wks, Addl Fetus 76810","code_information":[{"code":"2727328","type":"CDM"},{"code":"510","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.44,"discounted_cash":74.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":112.46,"discounted_cash":44.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":102.94,"discounted_cash":41.18,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob), Detailed, Single Fetus 76811","code_information":[{"code":"2727329","type":"CDM"},{"code":"510","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.95,"discounted_cash":235.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":353.97,"discounted_cash":141.59,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":199.55,"discounted_cash":79.82,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob), Detailed, Addt'l Fetus 76812","code_information":[{"code":"2727330","type":"CDM"},{"code":"510","type":"RC"},{"code":"76812","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.86,"discounted_cash":162.34,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":243.52,"discounted_cash":97.41,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":188.93,"discounted_cash":75.57,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob),1St Tri,Sngl/First Gest 76813","code_information":[{"code":"2727331","type":"CDM"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.2,"discounted_cash":49.68,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":124.2,"discounted_cash":49.68,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob), Limited Fetus(S) 76815","code_information":[{"code":"2727332","type":"CDM"},{"code":"510","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.32,"discounted_cash":122.13,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":183.2,"discounted_cash":73.28,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":140.0,"discounted_cash":56.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":67.63,"discounted_cash":27.05,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob), Follow-Up, Per Fetus 76816","code_information":[{"code":"2727333","type":"CDM"},{"code":"510","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.32,"discounted_cash":122.13,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":183.2,"discounted_cash":73.28,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":140.0,"discounted_cash":56.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":88.89,"discounted_cash":35.56,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob) Transvaginal 76817","code_information":[{"code":"2727334","type":"CDM"},{"code":"510","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.98,"discounted_cash":117.99,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":176.98,"discounted_cash":70.79,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":78.27,"discounted_cash":31.31,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us Fetal Biophysical Profile W/ Non-Str 76818","code_information":[{"code":"2727335","type":"CDM"},{"code":"510","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.98,"discounted_cash":117.99,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":176.98,"discounted_cash":70.79,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":110.68,"discounted_cash":44.27,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us Fetal Biophysical Profile W/Out Non-Str 76819","code_information":[{"code":"2727336","type":"CDM"},{"code":"510","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.98,"discounted_cash":117.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":176.98,"discounted_cash":70.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":294.98,"discounted_cash":117.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Doppler Velocimetry Fetal; Umb Art 76820","code_information":[{"code":"2727337","type":"CDM"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.9,"discounted_cash":57.96,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":51.96,"discounted_cash":20.78,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Non-Ob) Transvaginal 76830","code_information":[{"code":"2727339","type":"CDM"},{"code":"510","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.15,"discounted_cash":120.06,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":180.09,"discounted_cash":72.04,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":71.27,"discounted_cash":28.51,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Non-Ob) Pelvis Comp W/Transvag 76856","code_information":[{"code":"2727340","type":"CDM"},{"code":"510","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.98,"discounted_cash":117.99,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":176.98,"discounted_cash":70.79,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":69.53,"discounted_cash":27.81,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Non-Ob) Pelvis Ltd W/Transvag 76857","code_information":[{"code":"2727341","type":"CDM"},{"code":"510","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.15,"discounted_cash":120.06,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":180.09,"discounted_cash":72.04,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":49.68,"discounted_cash":19.87,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Echo Guide For Vascular Access 76937","code_information":[{"code":"2727348","type":"CDM"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.87,"discounted_cash":11.95,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":29.87,"discounted_cash":11.95,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Ht Muscle Image Spect, Mult 78452","code_information":[{"code":"2727395","type":"CDM"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":2587.5,"discounted_cash":1035.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":284.62,"discounted_cash":113.85,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Unattend Sleep Study,Type Iii Monitor G0399","code_information":[{"code":"2727776","type":"CDM"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.34,"discounted_cash":58.94,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":147.34,"discounted_cash":58.94,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Vaginal - Delivery Type:","code_information":[{"code":"2858314","type":"CDM"},{"code":"720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3444.0,"discounted_cash":1377.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C-Section - Delivery Type:","code_information":[{"code":"2858315","type":"CDM"},{"code":"360","type":"RC"},{"code":"59510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2322.0,"discounted_cash":928.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ceruloplasmin-(326)","code_information":[{"code":"2924314","type":"CDM"},{"code":"300","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Jo-1 Antibody-(5810)","code_information":[{"code":"2924316","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sex Binding Hormone Globulin (Shbg)-(30740)","code_information":[{"code":"2924317","type":"CDM"},{"code":"300","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88300 Ap Bill Surgical Pathology Level I Complexity","code_information":[{"code":"295346","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88302 Ap Bill Surgical Pathology Level Ii Complexity","code_information":[{"code":"295348","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88304 Ap Bill Surgical Pathology Level Iii Complexity","code_information":[{"code":"295350","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88305 Ap Bill Surgical Pathology Level Iv Complexity","code_information":[{"code":"295352","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88307 Ap Bill Surgical Pathology Level V Complexity","code_information":[{"code":"295354","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88309 Ap Bill Surgical Pathology Level Vi Complexity","code_information":[{"code":"295356","type":"CDM"},{"code":"310","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88311 Ap Bill Decalcification","code_information":[{"code":"295360","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88312 Ap Bill Special Stains Group I","code_information":[{"code":"295362","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88313 Ap Bill Special Stains Group Ii","code_information":[{"code":"295364","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88342 Ap Bill Immunoperoxidase, Initial","code_information":[{"code":"295366","type":"CDM"},{"code":"300","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":113.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88029 Ap Bill Autopsy Comprehensive Still/Nwbrn/Cns","code_information":[{"code":"295368","type":"CDM"},{"code":"310","type":"RC"},{"code":"88029","type":"HCPCS"}],"standard_charges":[{"gross_charge":1652.0,"discounted_cash":660.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88028 Ap Bill Autopsy Comprehensive Infant/Cns","code_information":[{"code":"295370","type":"CDM"},{"code":"310","type":"RC"},{"code":"88028","type":"HCPCS"}],"standard_charges":[{"gross_charge":1652.0,"discounted_cash":660.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88020 Ap Bill Autopsy Comprehensive W/O Cns","code_information":[{"code":"295372","type":"CDM"},{"code":"310","type":"RC"},{"code":"88020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1652.0,"discounted_cash":660.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88027 Ap Bill Autopsy Comprehensive Cns","code_information":[{"code":"295374","type":"CDM"},{"code":"310","type":"RC"},{"code":"88027","type":"HCPCS"}],"standard_charges":[{"gross_charge":1928.0,"discounted_cash":771.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88037 Ap Bill Autopsy Limited Single Organ","code_information":[{"code":"295376","type":"CDM"},{"code":"310","type":"RC"},{"code":"88037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":440.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88036 Ap Bill Autopsy Limited Regional","code_information":[{"code":"295378","type":"CDM"},{"code":"310","type":"RC"},{"code":"88036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":551.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88172 Ap Bill Fna Immediate Read","code_information":[{"code":"295386","type":"CDM"},{"code":"310","type":"RC"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88173 Ap Bill Fna Interp And Report","code_information":[{"code":"295388","type":"CDM"},{"code":"310","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Large Joint Or Bursa Arthrocenteses Aspiraton Or Injection","code_information":[{"code":"2966333","type":"CDM"},{"code":"510","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."},{"gross_charge":118.98,"discounted_cash":47.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Single Tendon Origin Insertion Injection","code_information":[{"code":"2966334","type":"CDM"},{"code":"510","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Gram Negative Identification (Vitek)","code_information":[{"code":"297662","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gram Positive Identification (Vitek)","code_information":[{"code":"297663","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yeast Identification (Vitek)","code_information":[{"code":"297694","type":"CDM"},{"code":"300","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Result Glucose, Whole Blood","code_information":[{"code":"3019321","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"3020784","type":"CDM"},{"code":"510","type":"RC"},{"code":"J3420","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Iv Infusion Ther/Prop/Dx; Initial, 16-90 Min 96365","code_information":[{"code":"3034317","type":"CDM"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.74,"discounted_cash":53.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Us Extremity Nonvascular Complete Bilat","code_information":[{"code":"3148320","type":"CDM"},{"code":"402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":395.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Extremity Nonvascular Limited","code_information":[{"code":"3148326","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":496.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Follicle Stimulating Hormone Level-(470)","code_information":[{"code":"3170314","type":"CDM"},{"code":"300","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prolactin-(746)","code_information":[{"code":"3170316","type":"CDM"},{"code":"300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":59.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Estradiol Level-(4021)","code_information":[{"code":"3170319","type":"CDM"},{"code":"300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":66.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Testosterone Total, Ms-(15983)","code_information":[{"code":"3170320","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Free T3 Level","code_information":[{"code":"3170323","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Free T4 Level","code_information":[{"code":"3170324","type":"CDM"},{"code":"300","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroglobulin Antibodies-(267)","code_information":[{"code":"3170328","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Valproic Acid Level","code_information":[{"code":"3170351","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Monospot: Whole Blood Poc","code_information":[{"code":"3322345","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.61,"discounted_cash":5.84,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Cortisol Total","code_information":[{"code":"3352314","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Cvc Tunneled Dialysis Catheter","code_information":[{"code":"3450362","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Filter Placement","code_information":[{"code":"3450368","type":"CDM"},{"code":"360","type":"RC"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":12280.0,"discounted_cash":4912.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Filter Removal","code_information":[{"code":"3450371","type":"CDM"},{"code":"320","type":"RC"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":9180.0,"discounted_cash":3672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Crystal Examination Body Fluid","code_information":[{"code":"3454316","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":23.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunoglobulin A-(539)","code_information":[{"code":"3454331","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunoglobulin G-(543)","code_information":[{"code":"3454332","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insulin Level Total-(561)","code_information":[{"code":"3454335","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prealbumin","code_information":[{"code":"3454341","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Psa, Free And Total-(31348)","code_information":[{"code":"3454342","type":"CDM"},{"code":"300","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Zzrheumatoid Factor, Qual","code_information":[{"code":"3454344","type":"CDM"},{"code":"300","type":"RC"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tacrolimus, Highly Sensitive, Lc/Ms/Ms-(34482)","code_information":[{"code":"3454351","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Varicella Zoster Virus Antibody Igg-(4439)","code_information":[{"code":"3454356","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Calcium, Ionized (Serum)-(306)","code_information":[{"code":"3454378","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Csf Cell Count Manual","code_information":[{"code":"3454393","type":"CDM"},{"code":"300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":66.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"D Dimer","code_information":[{"code":"3454399","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":94.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"U Mds","code_information":[{"code":"3454403","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":".Fasting Plasma Glucose","code_information":[{"code":"3454411","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gentamicin Level, Random","code_information":[{"code":"3454415","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gestational Diabetes Screen (Glucose)","code_information":[{"code":"3454416","type":"CDM"},{"code":"300","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Homocysteine Level-(31789)","code_information":[{"code":"3454428","type":"CDM"},{"code":"300","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":48.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunofixation, Serum-(549)","code_information":[{"code":"3454432","type":"CDM"},{"code":"300","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunofixation (Ife) Urine-(213)","code_information":[{"code":"3454433","type":"CDM"},{"code":"300","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mumps Virus Antibody (Igg)-(8624)","code_information":[{"code":"3454449","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oxycodone And Metabolite Level Quant-(18885)","code_information":[{"code":"3454451","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Progesterone Level, Immunoassay-(745)","code_information":[{"code":"3454459","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatinine W/Gfr","code_information":[{"code":"3454470","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroid Peroxidase Antibodies (Tpo)-(5081)","code_information":[{"code":"3454483","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chromogranin A-(16379)","code_information":[{"code":"3455048","type":"CDM"},{"code":"300","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microalbumin Level 24 Hour Urine","code_information":[{"code":"3455400","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein, Total & Electro Random Ur-(29808)","code_information":[{"code":"3455474","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Parathyroid Hormone Intact","code_information":[{"code":"3455481","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reducing Substances Urine","code_information":[{"code":"3455497","type":"CDM"},{"code":"300","type":"RC"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":13.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Retic Count","code_information":[{"code":"3455503","type":"CDM"},{"code":"300","type":"RC"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Fluidotherapy Units","code_information":[{"code":"3470348","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Canalith Repositioning Procedure Time","code_information":[{"code":"3470352","type":"CDM"},{"code":"420","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":87.6,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Diathermy Units","code_information":[{"code":"3470356","type":"CDM"},{"code":"420","type":"RC"},{"code":"97024","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Diathermy Time","code_information":[{"code":"3470357","type":"CDM"},{"code":"420","type":"RC"},{"code":"97024","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Med Joint Or Bursa Arthrocenteses Aspiraton Or Injection","code_information":[{"code":"3482314","type":"CDM"},{"code":"510","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":270.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":75.33,"discounted_cash":30.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Slp Eval Of Speech Fluency  Units","code_information":[{"code":"3624350","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Female Genital Syst,Unlisted Px 58999","code_information":[{"code":"3748406","type":"CDM"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.34,"discounted_cash":276.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Unlisted Procedure, Middle Ear 69799","code_information":[{"code":"3748417","type":"CDM"},{"code":"69799","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.08,"discounted_cash":164.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Hcg, Urine Poc","code_information":[{"code":"3770347","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.86,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Cbc Without Diff","code_information":[{"code":"3798345","type":"CDM"},{"code":"300","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Slp Biofeedback Training Units","code_information":[{"code":"3810995","type":"CDM"},{"code":"440","type":"RC"},{"code":"90901","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Slp Eval Speech Production Units","code_information":[{"code":"3811056","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":132.8,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Koh/Wet Prep Poc","code_information":[{"code":"3812347","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":4.64,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":12.0,"discounted_cash":4.8,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"PLASMA PROTEIN FRACTION5%50MLI","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"3870000001","type":"CDM"},{"code":"387","type":"RC"},{"code":"13533061320","type":"NDC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Home Health Certification G0180","code_information":[{"code":"3930345","type":"CDM"},{"code":"G0180","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":126.27,"discounted_cash":50.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Removal Of Nail Bed 11750","code_information":[{"code":"3942525","type":"CDM"},{"code":"510","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.08,"discounted_cash":308.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":462.64,"discounted_cash":185.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":308.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":771.08,"discounted_cash":308.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Removal Of Nail Plate 11730","code_information":[{"code":"3942526","type":"CDM"},{"code":"510","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":267.03,"discounted_cash":106.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":178.0,"discounted_cash":71.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":445.05,"discounted_cash":178.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Cmc Pacu - Or","code_information":[{"code":"3942614","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":48.41,"discounted_cash":19.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cmc Phase Ii - Or","code_information":[{"code":"3942615","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":23.86,"discounted_cash":9.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cmc Postproc - Ld","code_information":[{"code":"3942696","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Inter Lac Repair Ext/Scalp 2.5Cm Less 12031","code_information":[{"code":"3974366","type":"CDM"},{"code":"510","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.25,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":314.7,"discounted_cash":125.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Inter Lac Repair Ext/Scalp 2.6-7.5Cm 12032","code_information":[{"code":"3974367","type":"CDM"},{"code":"510","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.25,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":776.25,"discounted_cash":310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Lumbar Puncture 62270","code_information":[{"code":"4092346","type":"CDM"},{"code":"510","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1449.0,"discounted_cash":579.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":869.4,"discounted_cash":347.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":580.0,"discounted_cash":232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1449.0,"discounted_cash":579.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Echocardiogram Transthoracic With Bubble Study","code_information":[{"code":"4117453","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2544.0,"discounted_cash":1017.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Echocardiogram Dobutamine Stress","code_information":[{"code":"4120593","type":"CDM"},{"code":"480","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.0,"discounted_cash":616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri C-Spine W/O Contrast","code_information":[{"code":"4122507","type":"CDM"},{"code":"610","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cerebrospinal Fluid Culture/Gs","code_information":[{"code":"4122737","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anaerobic Culture","code_information":[{"code":"4122782","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blood Culture","code_information":[{"code":"4122800","type":"CDM"},{"code":"300","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Body Fluid Culture/Gs","code_information":[{"code":"4122803","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fungal Blood Culture","code_information":[{"code":"4122969","type":"CDM"},{"code":"300","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fungal Culture","code_information":[{"code":"4123005","type":"CDM"},{"code":"300","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":65.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Psa Screening","code_information":[{"code":"4123035","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sputum Culture/Gss","code_information":[{"code":"4123062","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gastroccult","code_information":[{"code":"4123208","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Carbamazepine Level","code_information":[{"code":"4123321","type":"CDM"},{"code":"300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Prostate W/ + W/O Contrast","code_information":[{"code":"4126347","type":"CDM"},{"code":"610","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":4658.0,"discounted_cash":1863.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Prostate W/O Contrast","code_information":[{"code":"4126350","type":"CDM"},{"code":"610","type":"RC"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.0,"discounted_cash":545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Voiding Urethrocystography","code_information":[{"code":"4126363","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Culture","code_information":[{"code":"4126493","type":"CDM"},{"code":"300","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phenobarbital Level","code_information":[{"code":"4149292","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Myringotomy Including Aspiration And/Or Eustachian Tube Inflation 69420","code_information":[{"code":"4149476","type":"CDM"},{"code":"510","type":"RC"},{"code":"69420","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.02,"discounted_cash":213.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":319.82,"discounted_cash":127.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":213.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":533.02,"discounted_cash":213.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Adamts13 Activity W/ Rfx To Inhibitor-(14532)","code_information":[{"code":"4149880","type":"CDM"},{"code":"300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":171.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunoglobulin M-(545)","code_information":[{"code":"4149964","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Percutaneous Cholecystostomy","code_information":[{"code":"4155445","type":"CDM"},{"code":"320","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":7998.0,"discounted_cash":3199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tc99M Pertechnetate Per Mci","code_information":[{"code":"4155550","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9512","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hysteroscopy 58565","code_information":[{"code":"4155630","type":"CDM"},{"code":"510","type":"RC"},{"code":"58565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2587.5,"discounted_cash":1035.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1552.5,"discounted_cash":621.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1035.0,"discounted_cash":414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":2587.5,"discounted_cash":1035.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Partial Hymenectomy 56700","code_information":[{"code":"4155632","type":"CDM"},{"code":"56700","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.68,"discounted_cash":149.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Chemical Peel Face Dermal","code_information":[{"code":"4155937","type":"CDM"},{"code":"510","type":"RC"},{"code":"15789","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.13,"discounted_cash":267.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":400.88,"discounted_cash":160.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Blepharoplasty Upper 15822","code_information":[{"code":"4155939","type":"CDM"},{"code":"15822","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.7,"discounted_cash":309.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Rhinoplasty 30400","code_information":[{"code":"4155984","type":"CDM"},{"code":"30400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1993.2,"discounted_cash":797.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cardiac Rehab Phase I Units","code_information":[{"code":"4157775","type":"CDM"},{"code":"943","type":"RC"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Miscellaneous Lab Test","code_information":[{"code":"4184836","type":"CDM"},{"code":"300","type":"RC"},{"code":"99999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amylase Random Urine W/ Creat-(8464)","code_information":[{"code":"4185033","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C3 Complement Component-(351)","code_information":[{"code":"4185039","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C4 Complement Component-(353)","code_information":[{"code":"4185042","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Echocardiogram Limited","code_information":[{"code":"4185151","type":"CDM"},{"code":"480","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.0,"discounted_cash":601.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage External Ear, Simple 69000","code_information":[{"code":"4185345","type":"CDM"},{"code":"510","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":838.35,"discounted_cash":335.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Removal Foreign Body Nose 30300","code_information":[{"code":"4185354","type":"CDM"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.97,"discounted_cash":99.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Closed Tx Of Nasal Bone Fx; W/ Stabilization 21320","code_information":[{"code":"4185355","type":"CDM"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.62,"discounted_cash":109.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Sialolithotomy 42330","code_information":[{"code":"4185356","type":"CDM"},{"code":"42330","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.79,"discounted_cash":134.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Oropharyngeal Biopsy 42800","code_information":[{"code":"4185357","type":"CDM"},{"code":"42800","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.35,"discounted_cash":90.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Incision And Drainage (I&D) Peritonsillar Abscess 42700","code_information":[{"code":"4185362","type":"CDM"},{"code":"510","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.02,"discounted_cash":213.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":319.82,"discounted_cash":127.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":213.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":533.02,"discounted_cash":213.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Control Bleeding, Oropharyngeal, Primary Or Secondary, Simple 42960","code_information":[{"code":"4185363","type":"CDM"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.25,"discounted_cash":138.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tongue Biopsy; Anterior Two-Thirds 41100","code_information":[{"code":"4185364","type":"CDM"},{"code":"510","type":"RC"},{"code":"41100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.08,"discounted_cash":474.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":711.04,"discounted_cash":284.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1185.08,"discounted_cash":474.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Floor Of Mouth Biopsy 41108","code_information":[{"code":"4185367","type":"CDM"},{"code":"41108","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.48,"discounted_cash":73.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Palate Or Uvula Biopsy 42100","code_information":[{"code":"4185369","type":"CDM"},{"code":"42100","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.58,"discounted_cash":89.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ear Canal Biopsy 69105","code_information":[{"code":"4185372","type":"CDM"},{"code":"510","type":"RC"},{"code":"69105","type":"HCPCS"}],"standard_charges":[{"gross_charge":3042.9,"discounted_cash":1217.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1825.74,"discounted_cash":730.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1217.0,"discounted_cash":486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3042.9,"discounted_cash":1217.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Potassium Urine","code_information":[{"code":"4185373","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ca 27-29-(29493)","code_information":[{"code":"4185592","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Capillary Blood Gases (Genlab)","code_information":[{"code":"4185610","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chloride Level Urine","code_information":[{"code":"4185628","type":"CDM"},{"code":"300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chloride Level 24 Hour Urine","code_information":[{"code":"4185630","type":"CDM"},{"code":"300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ph Body Fluid-(5367)","code_information":[{"code":"4186161","type":"CDM"},{"code":"300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phosphorus Urine","code_information":[{"code":"4186174","type":"CDM"},{"code":"300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phosphorus 24 Hour Urine","code_information":[{"code":"4186178","type":"CDM"},{"code":"300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Remove Fb Skin, Complex 10121","code_information":[{"code":"4186642","type":"CDM"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.29,"discounted_cash":148.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Bun 24 Hour Urine","code_information":[{"code":"4186644","type":"CDM"},{"code":"300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Uric Acid W/O Creatinine 24 Hour Urine-(11321)","code_information":[{"code":"4186651","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein Urine","code_information":[{"code":"4186691","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Factor Viii Activity, Clotting-(347)","code_information":[{"code":"4186807","type":"CDM"},{"code":"300","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose Urine","code_information":[{"code":"4186827","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Biopsy Lymph Node","code_information":[{"code":"4187435","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oxytocin Challenge Test","code_information":[{"code":"4188715","type":"CDM"},{"code":"920","type":"RC"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":241.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspirate Pleura W/O Imaging 32554","code_information":[{"code":"4192024","type":"CDM"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1112.62,"discounted_cash":445.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Surfactant Administration Units","code_information":[{"code":"4194927","type":"CDM"},{"code":"460","type":"RC"},{"code":"94610","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"*Paring Of Single Callus","code_information":[{"code":"4207333","type":"CDM"},{"code":"761","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"*Chemical Cauterization Of Wound","code_information":[{"code":"4207341","type":"CDM"},{"code":"761","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Maternity","code_information":[{"code":"4232583","type":"CDM"},{"code":"112","type":"RC"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":696.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiac Rehab Pii W/O Ecg Mtr Units","code_information":[{"code":"4232818","type":"CDM"},{"code":"943","type":"RC"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardic Rehab Pii W/Ecg Mntr Units","code_information":[{"code":"4232833","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pulmonary Rehab - 1 Hour Sess Units","code_information":[{"code":"4232841","type":"CDM"},{"code":"948","type":"RC"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Unna Boot Time","code_information":[{"code":"4235203","type":"CDM"},{"code":"420","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":206.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Unna Boot Units","code_information":[{"code":"4235204","type":"CDM"},{"code":"420","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":206.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Measured O2%","code_information":[{"code":"4235687","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":152.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pulmonary Rehab - 1 Hour Sess Units W Kx","code_information":[{"code":"4238031","type":"CDM"},{"code":"948","type":"RC"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Electrical Stimulation (Manual) Ea 15 Min Units","code_information":[{"code":"4238180","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Slp Eval Speech Prod W/Lang-Neuro Units","code_information":[{"code":"4238207","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Vitamin D 25-Hydroxy (D2, D3) Questassured (92888)","code_information":[{"code":"4240407","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prostatic Acid Phosphatase-(208)","code_information":[{"code":"4240426","type":"CDM"},{"code":"300","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bilirubin, Direct","code_information":[{"code":"4240528","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ca 125-(29256)","code_information":[{"code":"4240559","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":78.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hemosiderinstain, Urine-(518)","code_information":[{"code":"4240729","type":"CDM"},{"code":"300","type":"RC"},{"code":"83070","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"4240798","type":"CDM"},{"code":"300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Luteinizing Hormone-(615)","code_information":[{"code":"4240834","type":"CDM"},{"code":"300","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Regional Block","code_information":[{"code":"4243951","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":170.63,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Est Pt Wound Visit Level 5 (60 Plus Min) - *Wound Visit Levels","code_information":[{"code":"4247137","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Est Pt Wound Visit Level 4 (46-60 Min) - *Wound Visit Levels","code_information":[{"code":"4247138","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Est Pt Wound Visit Level 3 (31-45 Min) - *Wound Visit Levels","code_information":[{"code":"4247139","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Est Pt Wound Visit Level 2 (16-30 Min) - *Wound Visit Levels","code_information":[{"code":"4247140","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Est Pt Wound Visit Level 1 (0-15 Min) - *Wound Visit Levels","code_information":[{"code":"4247141","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Wound Visit Level 5 (60 Plus Min) - *Wound Visit Levels","code_information":[{"code":"4247142","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":291.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Wound Visit Level 4 (46-60 Min) - *Wound Visit Levels","code_information":[{"code":"4247143","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Wound Visit Level 3 (31-45 Min) - *Wound Visit Levels","code_information":[{"code":"4247144","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Wound Visit Level 2 (16-30 Min) - *Wound Visit Levels","code_information":[{"code":"4247145","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Wound Visit Level 1 (0-15 Min) - *Wound Visit Levels","code_information":[{"code":"4247146","type":"CDM"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ob Provider Laceration Repair","code_information":[{"code":"4289581","type":"CDM"},{"code":"761","type":"RC"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":6607.0,"discounted_cash":2642.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Initial - Rt Charge Bronch Eval","code_information":[{"code":"4514789","type":"CDM"},{"code":"460","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inr Poc","code_information":[{"code":"4521105","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":5.2,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":15.0,"discounted_cash":6.0,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":11.0,"discounted_cash":4.4,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Ear Impression, Each V5275","code_information":[{"code":"4609414","type":"CDM"},{"code":"V5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.62,"discounted_cash":31.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":77.62,"discounted_cash":31.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Ma/Nurse Collect 36415","code_information":[{"code":"4609984","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.63,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Inject Skin Lesions Less Than Or Equal Too  7 11900","code_information":[{"code":"4612279","type":"CDM"},{"code":"510","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":279.45,"discounted_cash":111.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":465.75,"discounted_cash":186.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Treatment Of Superficial Wound Dehiscence, Simple Closure 12020","code_information":[{"code":"4612333","type":"CDM"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.46,"discounted_cash":151.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Skin Full Graft 20Sq Cm/Less 15240","code_information":[{"code":"4612335","type":"CDM"},{"code":"510","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":3950.0,"discounted_cash":1580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":2370.0,"discounted_cash":948.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1817.0,"discounted_cash":726.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Mohs, Each Addtl Tissue Block After The First 5 Blocks, Any Stage","code_information":[{"code":"4612341","type":"CDM"},{"code":"510","type":"RC"},{"code":"17315","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.42,"discounted_cash":57.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":86.05,"discounted_cash":34.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Biopsy Vestibule Of Mouth 40808","code_information":[{"code":"4612682","type":"CDM"},{"code":"510","type":"RC"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":630.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":420.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":346.0,"discounted_cash":138.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Biopsy Of Penis","code_information":[{"code":"4612683","type":"CDM"},{"code":"510","type":"RC"},{"code":"54100","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":154.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Aerosol Treatment Total Time Minutes","code_information":[{"code":"4614032","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clos Txnose Fx W/O Stablz 21315","code_information":[{"code":"4614444","type":"CDM"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.53,"discounted_cash":122.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Subcutaneous Tumor Soft Tissue Neck Ant. Thorax Greater  Than 3Cm","code_information":[{"code":"4614447","type":"CDM"},{"code":"361","type":"RC"},{"code":"21552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.0,"discounted_cash":2360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3400.0,"discounted_cash":1360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":2500.0,"discounted_cash":1000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Ctrl Nosebld Postir Subsq 30906","code_information":[{"code":"4614456","type":"CDM"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.66,"discounted_cash":106.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Lesion Excision Mucosa And Submucosa Vestibule Of Mouth; Simple Repair 40812","code_information":[{"code":"4615876","type":"CDM"},{"code":"40812","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.08,"discounted_cash":161.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Of Lesion Of Tongue W Closure Anterior Two Thirds","code_information":[{"code":"4615879","type":"CDM"},{"code":"510","type":"RC"},{"code":"41112","type":"HCPCS"}],"standard_charges":[{"gross_charge":5283.68,"discounted_cash":2113.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3170.2,"discounted_cash":1268.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":2113.0,"discounted_cash":845.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":5283.68,"discounted_cash":2113.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Excision Of Lesion Of Palate/Uvula, Without Closure 42104","code_information":[{"code":"4615896","type":"CDM"},{"code":"42104","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.88,"discounted_cash":113.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Beta Strep Culture Group B","code_information":[{"code":"4616226","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vaginal, Vacuum Assist - Delivery Type:","code_information":[{"code":"4616263","type":"CDM"},{"code":"720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3444.0,"discounted_cash":1377.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fungal Smear","code_information":[{"code":"4616293","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge Nasotracheal Suction","code_information":[{"code":"4620066","type":"CDM"},{"code":"410","type":"RC"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge High Flow Nasal Cannula","code_information":[{"code":"4622735","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ppd Administration Poc","code_information":[{"code":"4623204","type":"CDM"},{"code":"309","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.16,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Zzphy-Thoracentsis W/O Image Guidance","code_information":[{"code":"4624626","type":"CDM"},{"code":"360","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1892.0,"discounted_cash":756.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debridement, Bone; Each Additional 20 Sq Cm 11047","code_information":[{"code":"4625750","type":"CDM"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.81,"discounted_cash":80.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Us (Ob) < 14 Wks, Addtl 76802","code_information":[{"code":"4631220","type":"CDM"},{"code":"510","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.43,"discounted_cash":52.17,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":78.26,"discounted_cash":31.3,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":86.73,"discounted_cash":34.69,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Us (Ob),1St Tri,Sngl/First Gest 76814","code_information":[{"code":"4631221","type":"CDM"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.33,"discounted_cash":41.73,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":104.33,"discounted_cash":41.73,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Hystrsonogrph W/Wo Dopplr 76831","code_information":[{"code":"4631223","type":"CDM"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.61,"discounted_cash":92.64,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":75.37,"discounted_cash":30.15,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Oxygen Flow Rate","code_information":[{"code":"4634670","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":152.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Breast Complete Left","code_information":[{"code":"4645474","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Breast Complete Right","code_information":[{"code":"4645477","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Breast Limited Left","code_information":[{"code":"4645480","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Breast Limited Right","code_information":[{"code":"4645483","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":155.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"External Cephalic Version 59412","code_information":[{"code":"4651254","type":"CDM"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.32,"discounted_cash":83.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Exc H-F-Nk-Sp B9 Plus Marg Greater Than  4.0 11426","code_information":[{"code":"5018190","type":"CDM"},{"code":"510","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":6500.0,"discounted_cash":2600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3900.0,"discounted_cash":1560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":2600.0,"discounted_cash":1040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":5625.22,"discounted_cash":2250.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Excision Benign Lesion Face/Ears/Eyelids/Nose/Lips/Mucous Memb 3.1-4Cm 11444","code_information":[{"code":"5018192","type":"CDM"},{"code":"510","type":"RC"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":3275.78,"discounted_cash":1310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1965.46,"discounted_cash":786.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1310.0,"discounted_cash":524.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3275.78,"discounted_cash":1310.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Excision Benign Lesion Face/Ears/Eyelids/Nose/Lips/Mucous Memb >4Cm 11446","code_information":[{"code":"5018193","type":"CDM"},{"code":"510","type":"RC"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":5625.22,"discounted_cash":2250.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3375.14,"discounted_cash":1350.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":2250.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":5625.22,"discounted_cash":2250.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Myelogram 2 Or More Regions W/ Inject","code_information":[{"code":"5182399","type":"CDM"},{"code":"320","type":"RC"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2333.0,"discounted_cash":933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Remove Fb From External Auditory Canal, W General Anesth 69205","code_information":[{"code":"5205828","type":"CDM"},{"code":"69205","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.52,"discounted_cash":81.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Repair Of Eardrum  69620","code_information":[{"code":"5205832","type":"CDM"},{"code":"69620","type":"HCPCS"}],"standard_charges":[{"gross_charge":981.04,"discounted_cash":392.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tympanoplasty W/O Mastoidectomy, W/O Ossicular Chain Recon 69631","code_information":[{"code":"5205833","type":"CDM"},{"code":"69631","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.07,"discounted_cash":708.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tympanoplasty W/ Mastoidectomy, W/O Ossic Chain Recon 69641","code_information":[{"code":"5205836","type":"CDM"},{"code":"69641","type":"HCPCS"}],"standard_charges":[{"gross_charge":2090.43,"discounted_cash":836.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove Intra-Aortic Balloon Pump (Iabp), Percutaneous 33968","code_information":[{"code":"5205843","type":"CDM"},{"code":"33968","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.23,"discounted_cash":27.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Abdomen Exploration For Postop Hemorrhage, Thrombosis Or Infection 35840","code_information":[{"code":"5205847","type":"CDM"},{"code":"35840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2414.2,"discounted_cash":965.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Umbilical Vein Cath, Newborn 36510","code_information":[{"code":"5205853","type":"CDM"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.22,"discounted_cash":47.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ligation/Biopsy Of Temporal Artery 37609","code_information":[{"code":"5205871","type":"CDM"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.71,"discounted_cash":264.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Drainage Heart Sac (Pericardiocentesis), Initial 33016","code_information":[{"code":"5205874","type":"CDM"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.38,"discounted_cash":97.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insert Pacemaker Pulse Generator Only W/Existing Dual Leads 33213","code_information":[{"code":"5205881","type":"CDM"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.7,"discounted_cash":280.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove & Replace Single Lead Pacemaker Generator Only 33227","code_information":[{"code":"5205885","type":"CDM"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.93,"discounted_cash":282.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Implant Patient-Activated Heart Event Recorder 33285","code_information":[{"code":"5205889","type":"CDM"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.38,"discounted_cash":217.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove Patient-Activated Heart Event Recorder 33284","code_information":[{"code":"5205890","type":"CDM"}],"standard_charges":[{"gross_charge":424.68,"discounted_cash":169.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Of Lip; Transverse Wedge W/ Primary Closure 40510","code_information":[{"code":"5205903","type":"CDM"},{"code":"40510","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.02,"discounted_cash":288.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Of Lip; V-Excision W/ Linear Closure 40520","code_information":[{"code":"5205904","type":"CDM"},{"code":"40520","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.58,"discounted_cash":290.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Of Lip Or Cheek Fold 40819","code_information":[{"code":"5205909","type":"CDM"},{"code":"40819","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.27,"discounted_cash":194.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Of Lingual Frenum (Frenectomy) 41115","code_information":[{"code":"5205911","type":"CDM"},{"code":"510","type":"RC"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":3027.38,"discounted_cash":1210.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1816.42,"discounted_cash":726.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1211.0,"discounted_cash":484.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3027.38,"discounted_cash":1210.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Laceration Of Tongue Repair, Floor Of Mouth, Over 2.6 Cm Or Complex 41252","code_information":[{"code":"5205912","type":"CDM"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.57,"discounted_cash":171.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Drain Abscess/Cyst/Hematoma From Dentoalveolar Structures 41800","code_information":[{"code":"5205914","type":"CDM"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.49,"discounted_cash":118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Of Uvula 42140","code_information":[{"code":"5205915","type":"CDM"},{"code":"42140","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.62,"discounted_cash":125.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Biopsy Of Salivary Glnd;Incisional 42405","code_information":[{"code":"5205916","type":"CDM"},{"code":"42405","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.05,"discounted_cash":184.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Parotid Gland/Tumor, Lateral Lobe W/ Facial Nerve 42415","code_information":[{"code":"5205918","type":"CDM"},{"code":"42415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2150.32,"discounted_cash":860.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision Submaxillary Gland 42440","code_information":[{"code":"5205919","type":"CDM"},{"code":"42440","type":"HCPCS"}],"standard_charges":[{"gross_charge":837.21,"discounted_cash":334.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Dilation Salivary Duct 42650","code_information":[{"code":"5205921","type":"CDM"},{"code":"42650","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.44,"discounted_cash":47.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"I&D Abscess, Retropharyngeal Or Parapharyngeal, Intraoral 42720","code_information":[{"code":"5205922","type":"CDM"},{"code":"42720","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.98,"discounted_cash":319.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Biopsy, Nasopharynx, Unknown Primary Lesion 42806","code_information":[{"code":"5205924","type":"CDM"},{"code":"42806","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.97,"discounted_cash":106.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Control Bleeding, Oropharyngeal, Primary Or Secondary, Complicated 42961","code_information":[{"code":"5205925","type":"CDM"},{"code":"42961","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.81,"discounted_cash":343.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Control Bleeding, Oropharynx, Prmy Or Second W Secondary Intervention 42962","code_information":[{"code":"5205926","type":"CDM"},{"code":"42962","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.11,"discounted_cash":421.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Esophagoscopy, Flexible Transoral, Diagnostic 43200","code_information":[{"code":"5205928","type":"CDM"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.66,"discounted_cash":91.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Esophagoscopy, Flexible Transoral, W/ Removal Of Foreign Body 43215","code_information":[{"code":"5205929","type":"CDM"},{"code":"43215","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.09,"discounted_cash":122.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Dilation Gastric/Duodenal Strictures 43245","code_information":[{"code":"5205930","type":"CDM"},{"code":"43245","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.98,"discounted_cash":151.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd, Flexible Transoral, W/ Removal Lesion Hot Biopsy Forceps 43250","code_information":[{"code":"5205931","type":"CDM"},{"code":"43250","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.87,"discounted_cash":146.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp Diagnostic, Includes Brushing Or Washing When Performed 43260","code_information":[{"code":"5205932","type":"CDM"},{"code":"43260","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.79,"discounted_cash":277.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Removal Of Embedded Foreign Body, Eyelid 67938","code_information":[{"code":"5206051","type":"CDM"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.49,"discounted_cash":91.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Vulvectomy Simple; Partial 56620","code_information":[{"code":"5206052","type":"CDM"},{"code":"56620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.11,"discounted_cash":414.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Colporrhaphy, Suture Of Injury Of Vagina (Nonobstetrical) 57200","code_information":[{"code":"5206054","type":"CDM"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.2,"discounted_cash":241.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Removal/Revision Of Sling For Stress Incontinence (Fascia/Synthetic) 57287","code_information":[{"code":"5206056","type":"CDM"},{"code":"57287","type":"HCPCS"}],"standard_charges":[{"gross_charge":1367.63,"discounted_cash":547.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Removal Of Ovary/Tube(S) 58720","code_information":[{"code":"5206062","type":"CDM"},{"code":"58720","type":"HCPCS"}],"standard_charges":[{"gross_charge":1474.13,"discounted_cash":589.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Removal Of Ovary(S) 58940","code_information":[{"code":"5206063","type":"CDM"},{"code":"58940","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.17,"discounted_cash":420.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Shave Epidermal Dermal Lesion Trunk Arms Legs Gt 2 Cm","code_information":[{"code":"5206074","type":"CDM"},{"code":"510","type":"RC"},{"code":"11303","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.66,"discounted_cash":59.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":89.8,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Shave Epidermal Dermal Lesion Scalp Neck Hands Feet Genitals Gt 2.0 Cm","code_information":[{"code":"5206075","type":"CDM"},{"code":"510","type":"RC"},{"code":"11308","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Shave Epidermal Dermal Lesion Face Ears Eyelids Nose Lips Mucous Memb 1.1 Cm To 2.0 Cm","code_information":[{"code":"5206076","type":"CDM"},{"code":"510","type":"RC"},{"code":"11312","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.3,"discounted_cash":62.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":94.38,"discounted_cash":37.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Shave Epidermal Dermal Lesion Face Ears Eyelids Nose Lip Mucous Memb Gt 2.0 Cm","code_information":[{"code":"5206077","type":"CDM"},{"code":"510","type":"RC"},{"code":"11313","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":110.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Excision Benign Lesion Face/Ears/Eyelids/Nose/Lips/Mucous Memb 2.1-3Cm 11443","code_information":[{"code":"5206079","type":"CDM"},{"code":"510","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":3260.25,"discounted_cash":1304.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1956.15,"discounted_cash":782.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1304.0,"discounted_cash":521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3260.25,"discounted_cash":1304.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Excision, Malignant Lesion, Trunk/Arms/Legs 0.6-1.0Cm 11601","code_information":[{"code":"5206087","type":"CDM"},{"code":"510","type":"RC"},{"code":"11601","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":844.56,"discounted_cash":337.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":563.0,"discounted_cash":225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Removal, Implantable Contraceptive Capsules 11976","code_information":[{"code":"5206096","type":"CDM"},{"code":"510","type":"RC"},{"code":"11976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":838.35,"discounted_cash":335.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Remove/Insert Drug Implant 11983","code_information":[{"code":"5206097","type":"CDM"},{"code":"510","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Repair Wound/Lesion,1.1-2.5Cm 13120","code_information":[{"code":"5206099","type":"CDM"},{"code":"510","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.66,"discounted_cash":189.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":284.2,"discounted_cash":113.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":189.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Complex Repair Eyelid/Nose/Ear/Lip, Each Addtl 5Cm Or Less 13153","code_information":[{"code":"5206101","type":"CDM"},{"code":"510","type":"RC"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.41,"discounted_cash":114.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":171.85,"discounted_cash":68.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Chemical Peel, Nonfacial; Epidermal","code_information":[{"code":"5206119","type":"CDM"},{"code":"510","type":"RC"},{"code":"15793","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":540.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct., Malig Lesion, Trunk, Diam 2.1 To 3.0 Cmr","code_information":[{"code":"5206125","type":"CDM"},{"code":"510","type":"RC"},{"code":"17263","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":282.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct. Malig Lesion Trunk Diam 3.1 To 4.0 Cm","code_information":[{"code":"5206126","type":"CDM"},{"code":"510","type":"RC"},{"code":"17264","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct., Malig Lesion, Scalp, Diam 2.1 To 3.0 Cm","code_information":[{"code":"5206127","type":"CDM"},{"code":"510","type":"RC"},{"code":"17273","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Destruct., Malig Lesion, Scalp, Diam 3.1 To 4.0 Cm","code_information":[{"code":"5206128","type":"CDM"},{"code":"510","type":"RC"},{"code":"17274","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Circumcision-Surgical Excision-Neonate 54160","code_information":[{"code":"5206139","type":"CDM"},{"code":"510","type":"RC"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1361.02,"discounted_cash":544.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":816.62,"discounted_cash":326.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1361.02,"discounted_cash":544.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"D&C After Delivery 59160","code_information":[{"code":"5206157","type":"CDM"},{"code":"59160","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.59,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Apply Multlay Comprs Lwr Leg 29581","code_information":[{"code":"5206165","type":"CDM"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.97,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cartilage Graft,Nasal Septum 20912","code_information":[{"code":"5206180","type":"CDM"},{"code":"20912","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.06,"discounted_cash":384.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Graft; Ear Cartilage, Autogenous, To Nose Or Ear 21235","code_information":[{"code":"5206187","type":"CDM"},{"code":"21235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1138.71,"discounted_cash":455.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Open Tx Orbital Floor Blowout Fracture; W/ Implant 21390","code_information":[{"code":"5206190","type":"CDM"},{"code":"21390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.47,"discounted_cash":638.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Drain Neck/Chest Lesion 21501","code_information":[{"code":"5206191","type":"CDM"},{"code":"21501","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.26,"discounted_cash":255.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Excision, Tumor, Soft Tissue Neck/Ant. Thorax, Subfascial; ? 5 Cm 21554","code_information":[{"code":"5206192","type":"CDM"},{"code":"21554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.85,"discounted_cash":587.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Destroy Nerve, Face Muscle 64612","code_information":[{"code":"5206546","type":"CDM"},{"code":"510","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":375.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Nerve Block Inj, Occipital 64405","code_information":[{"code":"5206563","type":"CDM"},{"code":"510","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":390.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":260.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Nerve Block, Other Peripheral 64450","code_information":[{"code":"5206565","type":"CDM"},{"code":"510","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":880.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1320.0,"discounted_cash":528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":880.0,"discounted_cash":352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Repair Nasal Stenosis 30465","code_information":[{"code":"5206612","type":"CDM"},{"code":"30465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1952.4,"discounted_cash":780.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remove Lung Catheter 32552","code_information":[{"code":"5206624","type":"CDM"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.78,"discounted_cash":129.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Yes - Rt Charge Ippb","code_information":[{"code":"5230164","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Admin Influenza Virus Vaccine (Medicare) G0008","code_information":[{"code":"5230187","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.11,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Admin Hepatitis B Vaccine (Medicare) G0010","code_information":[{"code":"5230196","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.68,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Initial - Rt Charge Chest Physiotherapy","code_information":[{"code":"5242521","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Subsequent - Rt Charge Chest Physiotherapy","code_information":[{"code":"5242523","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":71.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge Aerosol Demo/Eval","code_information":[{"code":"5245796","type":"CDM"},{"code":"419","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision & Drainage  Simple","code_information":[{"code":"5258145","type":"CDM"},{"code":"761","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision & Drainage Complicated Or Multi","code_information":[{"code":"5258146","type":"CDM"},{"code":"761","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision & Drainage Of Hematoma/Seroma","code_information":[{"code":"5258147","type":"CDM"},{"code":"761","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3886.0,"discounted_cash":1554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debride Subcutan First 20 Sq Cm","code_information":[{"code":"5258148","type":"CDM"},{"code":"761","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debride Muscle First 20 Sq Cm Or Less","code_information":[{"code":"5258149","type":"CDM"},{"code":"761","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1520.0,"discounted_cash":608.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debride Bone First 20 Sq Cm Or Less","code_information":[{"code":"5258150","type":"CDM"},{"code":"761","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debride Subcutan Each Add 20 Sq Cm","code_information":[{"code":"5258151","type":"CDM"},{"code":"761","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debride Muscle/Fascia Each Additional 20 Sq Cm","code_information":[{"code":"5258152","type":"CDM"},{"code":"761","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debride Bone Each Additional 20 Sq Cm","code_information":[{"code":"5258153","type":"CDM"},{"code":"761","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2272.0,"discounted_cash":908.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biopsy Skin Single Lesion","code_information":[{"code":"5258154","type":"CDM"},{"code":"761","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biopsy Skin Each Additional Leasion","code_information":[{"code":"5258155","type":"CDM"},{"code":"761","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Debridement 1-5","code_information":[{"code":"5258156","type":"CDM"},{"code":"761","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skin Substitute Graft Trunk/Arm/Leg First 26 Sq Cm","code_information":[{"code":"5258160","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"gross_charge":3791.0,"discounted_cash":1516.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skin Sub Graft Face/Neck/Nk/Fh/G First 25 Sq Cm","code_information":[{"code":"5258161","type":"CDM"},{"code":"761","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":6618.0,"discounted_cash":2647.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing/Debridement Burns Small","code_information":[{"code":"5258162","type":"CDM"},{"code":"761","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing/Debridement Burns Medium","code_information":[{"code":"5258163","type":"CDM"},{"code":"761","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Neg Press Wound Tx Nondme >50 Sq Cm","code_information":[{"code":"5258165","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Neg Press Wound Tx Nondme <=50 Sq Cm","code_information":[{"code":"5258166","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":428.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Neg Press Wound Tx Dme >50 Sq Cm","code_information":[{"code":"5258167","type":"CDM"},{"code":"761","type":"RC"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":402.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Neg Press Wound Tx Dme <=50 Sq Cm","code_information":[{"code":"5258168","type":"CDM"},{"code":"761","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":402.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge Mechanical Oscillation","code_information":[{"code":"5259270","type":"CDM"},{"code":"410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":220.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge Oxygen Therapy","code_information":[{"code":"5266987","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":152.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Body Plethysmography (Throacic Gas Volume) - Rt Charge Pft","code_information":[{"code":"5267128","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bronchoprovocation - Rt Charge Pft","code_information":[{"code":"5267129","type":"CDM"},{"code":"460","type":"RC"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":358.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Diffusion (Dlco) - Rt Charge Pft","code_information":[{"code":"5267130","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Flow Volume Loop Pediatric - Rt Charge Pft","code_information":[{"code":"5267131","type":"CDM"},{"code":"460","type":"RC"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gas Dilution - Rt Charge Pft","code_information":[{"code":"5267132","type":"CDM"},{"code":"460","type":"RC"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Maximum Breathing Capacity, Maximal Voluntary Ventilation (M - Rt Charge Pft","code_information":[{"code":"5267133","type":"CDM"},{"code":"460","type":"RC"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Non-Invasive Continuous Ear/Pulse Oximetry - Rt Charge Pft","code_information":[{"code":"5267135","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spirometry Before & After - Rt Charge Pft","code_information":[{"code":"5267139","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phy-Spirometry - Rt Charge Pft Physician","code_information":[{"code":"5268949","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phy-Pulmonary Function Test Plethysomgraphy - Rt Charge Pft Physician","code_information":[{"code":"5268950","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phy-Maximum Breathing Capacity/Mvv - Rt Charge Pft Physician","code_information":[{"code":"5268952","type":"CDM"},{"code":"460","type":"RC"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phy-Continuous Overnight Pulse Oximetry - Rt Charge Pft Physician","code_information":[{"code":"5268953","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":275.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phy-C0 Diffuse Capacity - Rt Charge Pft Physician","code_information":[{"code":"5268954","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":116.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phy-Bronchodilation Response Pre And Post Bd - Rt Charge Pft Physician","code_information":[{"code":"5268955","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spirometry - Rt Charge Pft","code_information":[{"code":"5274349","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rt Assist - Rt Charge Intubation Or Assist","code_information":[{"code":"5324597","type":"CDM"},{"code":"410","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rt Intubation - Rt Charge Intubation Or Assist","code_information":[{"code":"5324598","type":"CDM"},{"code":"410","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge Arterial Line Insertion","code_information":[{"code":"5396782","type":"CDM"},{"code":"761","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Subsequent - Rt Charge Mdi","code_information":[{"code":"5397048","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Initial - Rt Charge Mdi","code_information":[{"code":"5397049","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Subsequent - Rt Charge Aerosol Therapy","code_information":[{"code":"5397112","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Initial - Rt Charge Aerosol Therapy","code_information":[{"code":"5397113","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Heart Pacemaker   33206","code_information":[{"code":"5403889","type":"CDM"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.42,"discounted_cash":372.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Room/Bed: Pediatrics","code_information":[{"code":"5412974","type":"CDM"},{"code":"113","type":"RC"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":710.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Byp Angio W/Right Heart Cath (Rhc) 93457","code_information":[{"code":"5425510","type":"CDM"},{"code":"93457","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.8,"discounted_cash":297.12,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":742.8,"discounted_cash":297.12,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Doppler Echo, Limited Or F/U (Pro Fee) 93321","code_information":[{"code":"5425525","type":"CDM"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.59,"discounted_cash":21.44,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":15.01,"discounted_cash":6.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Lhc W/ Sca 93458","code_information":[{"code":"5425566","type":"CDM"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":305.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Inpatient Initial - Rt Charge Bronch Eval","code_information":[{"code":"5474452","type":"CDM"},{"code":"460","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lap Ect Pregnancy (Remove) 59151","code_information":[{"code":"5544178","type":"CDM"},{"code":"59151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1503.38,"discounted_cash":601.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Insert Cervical Dilator 59200","code_information":[{"code":"5544179","type":"CDM"},{"code":"510","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.28,"discounted_cash":275.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":412.96,"discounted_cash":165.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":275.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":688.28,"discounted_cash":275.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Cerclage 59320","code_information":[{"code":"5544180","type":"CDM"},{"code":"59320","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.75,"discounted_cash":123.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Surg Tx Missed Abortion 2Nd Tri 59821","code_information":[{"code":"5544181","type":"CDM"},{"code":"59821","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.39,"discounted_cash":284.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Scope W/ Adhesolysis 58660","code_information":[{"code":"5544185","type":"CDM"},{"code":"58660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.47,"discounted_cash":541.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Falope Rings 58671","code_information":[{"code":"5544186","type":"CDM"},{"code":"58671","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.6,"discounted_cash":291.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ovarian Cystectomy 58925","code_information":[{"code":"5544187","type":"CDM"},{"code":"58925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.33,"discounted_cash":599.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tah W/Mmk 58152","code_information":[{"code":"5544188","type":"CDM"},{"code":"58152","type":"HCPCS"}],"standard_charges":[{"gross_charge":2519.62,"discounted_cash":1007.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tvh W/Mmk 58267","code_information":[{"code":"5544190","type":"CDM"},{"code":"58267","type":"HCPCS"}],"standard_charges":[{"gross_charge":2120.65,"discounted_cash":848.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tvh >250 Gms 58290","code_information":[{"code":"5544191","type":"CDM"},{"code":"58290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2309.13,"discounted_cash":923.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Lavh W/Sapl-Oophorectomy >250 Gms 58554","code_information":[{"code":"5544194","type":"CDM"},{"code":"58554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2663.55,"discounted_cash":1065.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Colpocleisis (Le Forte Type) 57120","code_information":[{"code":"5544196","type":"CDM"},{"code":"57120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.55,"discounted_cash":408.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"A&P Repair W/Enterocele (Not Included In Sling) 57265","code_information":[{"code":"5544197","type":"CDM"},{"code":"57265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1836.07,"discounted_cash":734.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cold Knife Conization Of Cervix 57520","code_information":[{"code":"5544199","type":"CDM"},{"code":"57520","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.81,"discounted_cash":219.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Limited - Rt Charge Elr","code_information":[{"code":"5702196","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cpap Daily - Rt Charge Elr","code_information":[{"code":"5702197","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88142 Ap Bill Gyn Cytology - Pap Smear, Thin Prep","code_information":[{"code":"592813","type":"CDM"},{"code":"510","type":"RC"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"88332 Ap Bill Frozen Add'l Block","code_information":[{"code":"592815","type":"CDM"},{"code":"310","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":60.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88331 Ap Bill Frozen Single Specimen","code_information":[{"code":"592817","type":"CDM"},{"code":"310","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":73.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88323 Ap Bill Consultation Fee Outside Slides/Report Prep","code_information":[{"code":"592821","type":"CDM"},{"code":"310","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88329 Ap Bill Intraoperative Consult (Orc)","code_information":[{"code":"592951","type":"CDM"},{"code":"310","type":"RC"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Antibody Identification Interpretation","code_information":[{"code":"592965","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":83.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Diverticulectomy Hypopharynx Or Esophagus W/Wo Myotomy Cervix Approach 43130","code_information":[{"code":"5940219","type":"CDM"},{"code":"43130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.73,"discounted_cash":639.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Chemodenerv 1 Extrem 1-4 Ea 64643","code_information":[{"code":"5960166","type":"CDM"},{"code":"510","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":59.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":88.85,"discounted_cash":35.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Chemodenerv 1 Extrem 5/> Ea 64645","code_information":[{"code":"5960168","type":"CDM"},{"code":"510","type":"RC"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.75,"discounted_cash":67.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":100.65,"discounted_cash":40.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Excise Parotid Tumor/Gland W/Face Nerve Disect/Preserv 42420","code_information":[{"code":"5972209","type":"CDM"},{"code":"42420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.28,"discounted_cash":966.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Esophagoscopy Rigid Transoral, Diagnostic 43191","code_information":[{"code":"5972210","type":"CDM"},{"code":"43191","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.05,"discounted_cash":125.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Egd Lesion Ablation 43270","code_information":[{"code":"5972212","type":"CDM"},{"code":"43270","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.21,"discounted_cash":244.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp Duct Stent Placement 43274","code_information":[{"code":"5972213","type":"CDM"},{"code":"43274","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.99,"discounted_cash":395.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp Remove Forgn Body Duct 43275","code_information":[{"code":"5972214","type":"CDM"},{"code":"43275","type":"HCPCS"}],"standard_charges":[{"gross_charge":805.75,"discounted_cash":322.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Ercp W/Removal/Exchange Stents Includes Pre/Post Dilation Sphincterotomy 43276","code_information":[{"code":"5972215","type":"CDM"},{"code":"43276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.29,"discounted_cash":411.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Place Gastrostomy Tube   43830","code_information":[{"code":"5972216","type":"CDM"},{"code":"43830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1404.97,"discounted_cash":561.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Chemodenerv Musc Neck Dyston 64616","code_information":[{"code":"5972227","type":"CDM"},{"code":"510","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":375.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Lc Skin Sub App Trnk/Arm/Leg  To 25 Sqcm","code_information":[{"code":"6069178","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1520.0,"discounted_cash":608.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lc Skin Sub App Trnk/Arm/Leg  Ad 25 Sqcm","code_information":[{"code":"6069179","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":304.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lc Skin Sub App Trnk/Arm/Leg Up 100Sqcm","code_information":[{"code":"6069180","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"gross_charge":7578.0,"discounted_cash":3031.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lc Skin Sub App Trnk/Arm/Leg Ad 100Sqcm","code_information":[{"code":"6069181","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"gross_charge":3791.0,"discounted_cash":1516.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunization Admin One Vaccine","code_information":[{"code":"6069182","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lc Skin Sub App Face/Nck/Hf  To 25 Sqcm","code_information":[{"code":"6069183","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1520.0,"discounted_cash":608.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lc Skin Sub App Face/Nck/Hf Ad 25 Sqcm","code_information":[{"code":"6069184","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":500.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lc Skin Sub App Face/Nck/Hf To100Sqcm","code_information":[{"code":"6069185","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5277","type":"HCPCS"}],"standard_charges":[{"gross_charge":5004.0,"discounted_cash":2001.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lc Skin Sub App Face/Nck/Hf Ad 100Sqcm","code_information":[{"code":"6069187","type":"CDM"},{"code":"761","type":"RC"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2503.0,"discounted_cash":1001.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Paring/Cutting Benign Lesion 2-4","code_information":[{"code":"6069194","type":"CDM"},{"code":"761","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Paring/Cutting Benign Lesion Over 4","code_information":[{"code":"6069195","type":"CDM"},{"code":"761","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trim Nails Any Number","code_information":[{"code":"6069196","type":"CDM"},{"code":"761","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing/Debridement Burns, Large","code_information":[{"code":"6069198","type":"CDM"},{"code":"761","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skin Sub Grft Trnk/Arm/Leg Ch Ad 100Sqcm","code_information":[{"code":"6069204","type":"CDM"},{"code":"761","type":"RC"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skin Sub Grft Trk/Arm/Leg Ch 1St 100Sqcm","code_information":[{"code":"6069205","type":"CDM"},{"code":"761","type":"RC"},{"code":"15273","type":"HCPCS"}],"standard_charges":[{"gross_charge":9383.0,"discounted_cash":3753.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skin Sub Grft Trk/Arm/Leg Ch Ad 25 Sqcm","code_information":[{"code":"6069206","type":"CDM"},{"code":"761","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skin Sub Grft Fce/Nck/Fh/G Ch Ad 100Sqcm","code_information":[{"code":"6069207","type":"CDM"},{"code":"761","type":"RC"},{"code":"15278","type":"HCPCS"}],"standard_charges":[{"gross_charge":4360.0,"discounted_cash":1744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skin Sub Grft Fce/Nck/Fh/G Ch Ad 20Sqcm","code_information":[{"code":"6069208","type":"CDM"},{"code":"761","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":2875.0,"discounted_cash":1150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Debridement 6 Or More","code_information":[{"code":"6069210","type":"CDM"},{"code":"761","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Pregnancy Test Poc","code_information":[{"code":"607612","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ligate/Transect Fallopian Tubes 58600","code_information":[{"code":"6140921","type":"CDM"},{"code":"58600","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.92,"discounted_cash":291.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Division Of Fallopian Tube 58605","code_information":[{"code":"6140924","type":"CDM"},{"code":"58605","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.03,"discounted_cash":263.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Esophagoscopy Flex/Transoral/Biopsy Sngl Or Mult 43202","code_information":[{"code":"6228167","type":"CDM"},{"code":"43202","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.77,"discounted_cash":90.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Esophagoscopy Flex/Transoral/Balloon Dilat < 30 Mm 43220","code_information":[{"code":"6228173","type":"CDM"},{"code":"43220","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.03,"discounted_cash":103.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Upper Gi Endoscopy Injx Sclerosis Esoph, Gast Varices 43243","code_information":[{"code":"6228178","type":"CDM"},{"code":"43243","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.04,"discounted_cash":204.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Enteroscopy Greater Than 2Nd Prtn W/ Remvl Lesion Snare 44364","code_information":[{"code":"6228239","type":"CDM"},{"code":"44364","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.13,"discounted_cash":176.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Enteroscopy > 2Nd Prtn Abltj Lesion 44369","code_information":[{"code":"6228242","type":"CDM"},{"code":"44369","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.96,"discounted_cash":212.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Sigmoidoscopy Flex Control Bleeding 45334","code_information":[{"code":"6228250","type":"CDM"},{"code":"45334","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.48,"discounted_cash":131.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Sigmoidoscopy Flex Directed Submucosal Injx 45335","code_information":[{"code":"6228251","type":"CDM"},{"code":"45335","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.95,"discounted_cash":74.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Xr Abdomen Kub 1 View - Report","code_information":[{"code":"625615","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Inflammation Loc Whole Body - Report","code_information":[{"code":"625637","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rt Charge Tobacco Getting Ready Quit 2","code_information":[{"code":"6266284","type":"CDM"},{"code":"942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge Tobacco Getting Ready Quit 1","code_information":[{"code":"6275465","type":"CDM"},{"code":"942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Yes - Rt Charge Tobacco Getting Ready Quit 2","code_information":[{"code":"6275470","type":"CDM"},{"code":"942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Excision Of Bone (Eg, Osteomyelitis Or Bone Abscess), Facial Bone(S) 21026","code_information":[{"code":"6275591","type":"CDM"},{"code":"21026","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.93,"discounted_cash":401.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Mri Breast W/O Contrast Bilateral - Report","code_information":[{"code":"627705","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonscopy, Flex, W/Ablation Of Tumor/Polyp/Lesion 45388","code_information":[{"code":"6290614","type":"CDM"},{"code":"45388","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.5,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Xr Knee 4 Views Bilateral - Report","code_information":[{"code":"630392","type":"CDM"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Knee 3 Views Right - Report","code_information":[{"code":"630396","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Knee 3 Views Left - Report","code_information":[{"code":"630404","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Neck W/O Contrast - Report","code_information":[{"code":"630744","type":"CDM"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Ob Greater Than 14 Weeks - Report","code_information":[{"code":"630920","type":"CDM"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.08,"discounted_cash":111.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Amylase Level","code_information":[{"code":"631567","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose Level","code_information":[{"code":"633594","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blood Urea Nitrogen","code_information":[{"code":"633605","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatinine Clearance","code_information":[{"code":"633609","type":"CDM"},{"code":"300","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrolyte Panel","code_information":[{"code":"633610","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sodium Level","code_information":[{"code":"633611","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sodium Level 24 Hour Urine","code_information":[{"code":"633613","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Potassium Level","code_information":[{"code":"633616","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Potassium Level 24 Hour Urine","code_information":[{"code":"633618","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chloride Level","code_information":[{"code":"633621","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Basic Metabolic Panel","code_information":[{"code":"633628","type":"CDM"},{"code":"300","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alt","code_information":[{"code":"633632","type":"CDM"},{"code":"300","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ast","code_information":[{"code":"633633","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alpha Fetoprotein Tumor Marker-(237)","code_information":[{"code":"633643","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anti-Streptolysin O Antibody (Aso)-(265)","code_information":[{"code":"633657","type":"CDM"},{"code":"300","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hcg Qualitative Serum","code_information":[{"code":"633663","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hcg Qualitative Urine","code_information":[{"code":"633664","type":"CDM"},{"code":"300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hcg, Beta Quant","code_information":[{"code":"633665","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bicarbonate Level","code_information":[{"code":"633667","type":"CDM"},{"code":"300","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bilirubin Total","code_information":[{"code":"633672","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bleeding Time","code_information":[{"code":"633674","type":"CDM"},{"code":"300","type":"RC"},{"code":"85002","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":23.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cbc W/ Manual Diff","code_information":[{"code":"633682","type":"CDM"},{"code":"300","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cbc W/ Diff","code_information":[{"code":"633683","type":"CDM"},{"code":"300","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Carcinoembryonic Antigen-(978)","code_information":[{"code":"633697","type":"CDM"},{"code":"300","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cell Count W/ Diff Body Fluid","code_information":[{"code":"633699","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":66.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Csf Cell Ct W/Diff","code_information":[{"code":"633700","type":"CDM"},{"code":"300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":66.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cholesterol Total","code_information":[{"code":"633705","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Comprehensive Metabolic Panel","code_information":[{"code":"633709","type":"CDM"},{"code":"300","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.0,"discounted_cash":180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatine Kinase","code_information":[{"code":"633712","type":"CDM"},{"code":"300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fibrinogen Level","code_information":[{"code":"633728","type":"CDM"},{"code":"300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gentamicin Level, Peak","code_information":[{"code":"633736","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gentamicin Level, Trough","code_information":[{"code":"633737","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucagon Level-(519)","code_information":[{"code":"633738","type":"CDM"},{"code":"300","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hemoglobin","code_information":[{"code":"633741","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hematocrit","code_information":[{"code":"633742","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatic (Liver) Function Panel - Lfts","code_information":[{"code":"633744","type":"CDM"},{"code":"300","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iron Level","code_information":[{"code":"633765","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lactate Dehydrogenase","code_information":[{"code":"633770","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Legionella Antigen, Eia, Urine-(8856)","code_information":[{"code":"633775","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":38.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lipase Level","code_information":[{"code":"633776","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lipid Panel","code_information":[{"code":"633777","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Magnesium Level","code_information":[{"code":"633781","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Infectious Mononucleosis Screen","code_information":[{"code":"633785","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prothrombin Time And Inr","code_information":[{"code":"633793","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Partial Thromboplastin Time","code_information":[{"code":"633794","type":"CDM"},{"code":"300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phenytoin Level","code_information":[{"code":"633801","type":"CDM"},{"code":"300","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phosphorus Level","code_information":[{"code":"633803","type":"CDM"},{"code":"300","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein, Total (Serum)","code_information":[{"code":"633818","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rapid Plasma Reagin","code_information":[{"code":"633820","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"T3 , Total Level-(859)","code_information":[{"code":"633833","type":"CDM"},{"code":"300","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroid Stimulating Hormone","code_information":[{"code":"633844","type":"CDM"},{"code":"300","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Total T4 Level","code_information":[{"code":"633845","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Transferrin","code_information":[{"code":"633851","type":"CDM"},{"code":"300","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Triglycerides","code_information":[{"code":"633852","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Uric Acid","code_information":[{"code":"633858","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ua Micro","code_information":[{"code":"633864","type":"CDM"},{"code":"300","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin B12 Level","code_information":[{"code":"633871","type":"CDM"},{"code":"300","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"White Cell Count","code_information":[{"code":"633873","type":"CDM"},{"code":"300","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Manual Differential","code_information":[{"code":"633876","type":"CDM"},{"code":"300","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bone Marrow Culture/Gs","code_information":[{"code":"633884","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ear Culture","code_information":[{"code":"633890","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Eye Culture/Gs","code_information":[{"code":"633892","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Genital Culture","code_information":[{"code":"633894","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gc Culture","code_information":[{"code":"633895","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nasal Culture","code_information":[{"code":"633900","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stool Culture","code_information":[{"code":"633904","type":"CDM"},{"code":"300","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Throat Culture","code_information":[{"code":"633905","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tissue Culture/Gs","code_information":[{"code":"633906","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wound Culture/Gs","code_information":[{"code":"633908","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gram Stain","code_information":[{"code":"633910","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pinworm Examination","code_information":[{"code":"633912","type":"CDM"},{"code":"300","type":"RC"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"India Ink","code_information":[{"code":"634093","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Acid Fast Stain Report Direct","code_information":[{"code":"634214","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Macroscopic Exam Report","code_information":[{"code":"634216","type":"CDM"},{"code":"300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gram Stain Report","code_information":[{"code":"634217","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta Lactamase","code_information":[{"code":"634293","type":"CDM"},{"code":"300","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Abo/Rh","code_information":[{"code":"634326","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Antibody Screen","code_information":[{"code":"634329","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Direct Antiglobulin Test","code_information":[{"code":"634331","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":35.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Antigen Type","code_information":[{"code":"634332","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fetal Maternal Hemorrhage Screen","code_information":[{"code":"634335","type":"CDM"},{"code":"300","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"ABOBOTULINUMTOXIN A 500U VL NC","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"6360000005","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0586","type":"HCPCS"},{"code":"15054050001A","type":"NDC"}],"standard_charges":[{"gross_charge":17.36,"discounted_cash":6.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 240 50ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360000007","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141230A","type":"NDC"}],"standard_charges":[{"gross_charge":222.55,"discounted_cash":89.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE 250MG/250ML BAG","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"6360000008","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00338107302A","type":"NDC"}],"standard_charges":[{"gross_charge":92.61,"discounted_cash":37.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 1G/50ML PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360000010","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00264315311A","type":"NDC"}],"standard_charges":[{"gross_charge":72.93,"discounted_cash":29.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 5G/100ML VIAL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360000012","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027638A","type":"NDC"}],"standard_charges":[{"gross_charge":326.31,"discounted_cash":130.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 500MG VL","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"6360000013","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023017204","type":"NDC"}],"standard_charges":[{"gross_charge":344.98,"discounted_cash":137.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 300MG/50ML VL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360000014","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"70860020050A","type":"NDC"}],"standard_charges":[{"gross_charge":658.36,"discounted_cash":263.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOVOSEVEN 1000U VIAL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360000015","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"00169720101A","type":"NDC"}],"standard_charges":[{"gross_charge":11654.97,"discounted_cash":4661.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"NOVOSEVEN 2000U VIAL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360000016","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"00169720201B","type":"NDC"}],"standard_charges":[{"gross_charge":23309.94,"discounted_cash":9323.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MCG"}]},{"description":"NOVOSEVEN 5000U VIAL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360000017","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"00169720501A","type":"NDC"}],"standard_charges":[{"gross_charge":58272.53,"discounted_cash":23309.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 MCG"}]},{"description":"NOVOSEVEN 8000U VIAL","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360000018","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"00169720801A","type":"NDC"}],"standard_charges":[{"gross_charge":93235.12,"discounted_cash":37294.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8000 MCG"}]},{"description":"LEUCOVORIN 350MG VIAL","drug_information":{"unit":"350","type":"ME"},"code_information":[{"code":"6360000019","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035A","type":"NDC"}],"standard_charges":[{"gross_charge":148.09,"discounted_cash":59.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMDESIVIR 100MG","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360000064","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0248","type":"HCPCS"},{"code":"61958290102A","type":"NDC"}],"standard_charges":[{"gross_charge":2593.27,"discounted_cash":1037.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SINUVA IMPLANT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360000065","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7402","type":"HCPCS"},{"code":"10599000301A","type":"NDC"}],"standard_charges":[{"gross_charge":6656.35,"discounted_cash":2662.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1350 MCG"}]},{"description":"TRASTUZUMAB 150MG INJ","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"6360000070","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"50242013201A","type":"NDC"}],"standard_charges":[{"gross_charge":6493.12,"discounted_cash":2597.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin Sod/D5W 25,000u/500ml","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"6360000071","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323052277A","type":"NDC"}],"standard_charges":[{"gross_charge":52.16,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENRALIZUMAB 30MG/ML SYR","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360000072","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0517","type":"HCPCS"},{"code":"00310173030A","type":"NDC"}],"standard_charges":[{"gross_charge":20393.88,"discounted_cash":8157.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB 1 MG INJECTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360000106","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377412A","type":"NDC"}],"standard_charges":[{"gross_charge":6906.4,"discounted_cash":2762.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB 1 MG INJECTION","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360000107","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211B","type":"NDC"}],"standard_charges":[{"gross_charge":5747.53,"discounted_cash":2299.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Rituxan Hycela 1400mg vial","drug_information":{"unit":"11.7","type":"ML"},"code_information":[{"code":"6360000108","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9311","type":"HCPCS"},{"code":"50242010801A","type":"NDC"}],"standard_charges":[{"gross_charge":32797.75,"discounted_cash":13119.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Givosiran 189mg/ml vial","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360000109","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0223","type":"HCPCS"},{"code":"71336100101A","type":"NDC"}],"standard_charges":[{"gross_charge":200329.74,"discounted_cash":80131.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1000MG","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"6360000110","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00781309895A","type":"NDC"}],"standard_charges":[{"gross_charge":134.63,"discounted_cash":53.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1000MG","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"6360000110","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00781309895B","type":"NDC"}],"standard_charges":[{"gross_charge":134.63,"discounted_cash":53.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIROLIMUS 1MG/ML LIQ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360000115","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"69238159403A","type":"NDC"}],"standard_charges":[{"gross_charge":167.85,"discounted_cash":67.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTAGAM IVIG 30G 300ML VL","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"6360000130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085005A","type":"NDC"}],"standard_charges":[{"gross_charge":25822.5,"discounted_cash":10329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Daratumumab 100mg/5ml vial","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360000146","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050505A","type":"NDC"}],"standard_charges":[{"gross_charge":2904.21,"discounted_cash":1161.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Daratumumab 400mg/20ml vial","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360000147","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050520A","type":"NDC"}],"standard_charges":[{"gross_charge":11616.83,"discounted_cash":4646.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Adenosine 90mg/30mL vial","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"6360000153","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"55150019301A","type":"NDC"}],"standard_charges":[{"gross_charge":808.56,"discounted_cash":323.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Kisunla 350mg/20ml vial","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360000175","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0175","type":"HCPCS"},{"code":"00002940101A","type":"NDC"}],"standard_charges":[{"gross_charge":2996.86,"discounted_cash":1198.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 2MG TAB","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"6360000180","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"00054817625A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE 60MG/2ML VIAL","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360000182","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618210A","type":"NDC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHL 10MEQ/100ML IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360000184","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948A","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Glassia, ALPHA-1 PROT. INHIB","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"6360000257","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0257","type":"HCPCS"},{"code":"00944288402A","type":"NDC"}],"standard_charges":[{"gross_charge":30.14,"discounted_cash":12.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Kcentra ~1000u vial","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"6360000281","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7168","type":"HCPCS"},{"code":"63833038702A","type":"NDC"}],"standard_charges":[{"gross_charge":162.9,"discounted_cash":65.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Mirena 52mg system","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360000423","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7298","type":"HCPCS"},{"code":"50419042301A","type":"NDC"}],"standard_charges":[{"gross_charge":5232.62,"discounted_cash":2093.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RUXIENCE 500MG/50ML VIAL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360000500","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901A","type":"NDC"}],"standard_charges":[{"gross_charge":17873.57,"discounted_cash":7149.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RUXIENCE 100MG/10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360000501","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069023801A","type":"NDC"}],"standard_charges":[{"gross_charge":3574.71,"discounted_cash":1429.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEGARELIX ACETATE 80MG VIAL","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"6360000510","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9155","type":"HCPCS"},{"code":"55566830301K","type":"NDC"}],"standard_charges":[{"gross_charge":2435.92,"discounted_cash":974.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Pegfilgrastim-BMEZ 6mg/0.6ml S","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"6360000511","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5120","type":"HCPCS"},{"code":"61314086602A","type":"NDC"}],"standard_charges":[{"gross_charge":19576.83,"discounted_cash":7830.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHT/TET/PERT BOOSTRIX 0.5ML","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360000530","type":"CDM"},{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084252A","type":"NDC"}],"standard_charges":[{"gross_charge":239.12,"discounted_cash":95.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 1G/50ML IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360000533","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"44567062024A","type":"NDC"}],"standard_charges":[{"gross_charge":112.49,"discounted_cash":45.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Leqembi 200mg/2ml vial","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360000577","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0174","type":"HCPCS"},{"code":"62856021201A","type":"NDC"}],"standard_charges":[{"gross_charge":1152.6,"discounted_cash":461.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Phesgo 600mg-600mg-20000u","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360000600","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242026001A","type":"NDC"}],"standard_charges":[{"gross_charge":40233.61,"discounted_cash":16093.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Meningococcal B vaccine","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360000620","type":"CDM"},{"code":"636","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"58160097602A","type":"NDC"}],"standard_charges":[{"gross_charge":955.63,"discounted_cash":382.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Leucovorin 500mg vial","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"6360000711","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323071100A","type":"NDC"}],"standard_charges":[{"gross_charge":448.29,"discounted_cash":179.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAGARD 10G/100ML VL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360001000","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005A","type":"NDC"}],"standard_charges":[{"gross_charge":6795.26,"discounted_cash":2718.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAGARD 20G/200ML VL","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"6360001001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006A","type":"NDC"}],"standard_charges":[{"gross_charge":13587.04,"discounted_cash":5434.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Gastroview-MD 30ml vial","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"6360001014","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044535A","type":"NDC"}],"standard_charges":[{"gross_charge":117.47,"discounted_cash":46.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Monoferric 1000mg/10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360001093","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1437","type":"HCPCS"},{"code":"73594931001A","type":"NDC"}],"standard_charges":[{"gross_charge":12696.11,"discounted_cash":5078.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INJ,BEZLOTOXUMAB,10MG","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"6360001107","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0565","type":"HCPCS"},{"code":"00006302500A","type":"NDC"}],"standard_charges":[{"gross_charge":18950.79,"discounted_cash":7580.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSL REG IN 0.9%NACL 100U/100M","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360001140","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00338012612A","type":"NDC"}],"standard_charges":[{"gross_charge":199.34,"discounted_cash":79.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECENTRIQ 840MG/14ML VIAL","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"6360001150","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091801A","type":"NDC"}],"standard_charges":[{"gross_charge":32146.09,"discounted_cash":12858.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECENTRIQ 1200MG/20ML VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360001151","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091701A","type":"NDC"}],"standard_charges":[{"gross_charge":45851.11,"discounted_cash":18340.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Phesgo 1200mg-600mg-30000u","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"6360001200","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242024501A","type":"NDC"}],"standard_charges":[{"gross_charge":60352.79,"discounted_cash":24141.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Glassia ~4000mg vial","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"6360001257","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0257","type":"HCPCS"},{"code":"00944288403A","type":"NDC"}],"standard_charges":[{"gross_charge":28.7,"discounted_cash":11.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine 200mg/5ml vial","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360001265","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00409582001a","type":"NDC"}],"standard_charges":[{"gross_charge":27.84,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMM GLOB 20GM IV","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"6360001344","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085004A","type":"NDC"}],"standard_charges":[{"gross_charge":17225.26,"discounted_cash":6890.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Omnipaque 300mg/ml 100ml vl","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360001363","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141363A","type":"NDC"}],"standard_charges":[{"gross_charge":515.92,"discounted_cash":206.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES IMM GLO 1,500 IU/5 ML V","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360001401","type":"CDM"},{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031805A","type":"NDC"}],"standard_charges":[{"gross_charge":16717.54,"discounted_cash":6687.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES IMM GLO 300 IU/1 ML VL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360001402","type":"CDM"},{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031801A","type":"NDC"}],"standard_charges":[{"gross_charge":3343.53,"discounted_cash":1337.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INJ,PEGFILGRASTIM CBQV BIO 0.5","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"6360001403","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114010101A","type":"NDC"}],"standard_charges":[{"gross_charge":16026.16,"discounted_cash":6410.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DECITABINE 50MG VIAL","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"6360001404","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"25021023120A","type":"NDC"}],"standard_charges":[{"gross_charge":4996.29,"discounted_cash":1998.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPOLIZUMAB 100MG VIAL","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360001407","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2182","type":"HCPCS"},{"code":"00173088101A","type":"NDC"}],"standard_charges":[{"gross_charge":15330.61,"discounted_cash":6132.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TBO0FILGRASTIM 480 MCG VIAL","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"6360001440","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211A","type":"NDC"}],"standard_charges":[{"gross_charge":1994.28,"discounted_cash":797.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TBO0FILGRASTIM 300 MCG VIAL","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360001441","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091011A","type":"NDC"}],"standard_charges":[{"gross_charge":1246.06,"discounted_cash":498.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DALBAVANCIN 500 MG VIAL","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"6360001442","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0875","type":"HCPCS"},{"code":"57970010001A","type":"NDC"}],"standard_charges":[{"gross_charge":8057.79,"discounted_cash":3223.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Privigen 40g/400ml IV","drug_information":{"unit":"400","type":"ML"},"code_information":[{"code":"6360001459","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043940A","type":"NDC"}],"standard_charges":[{"gross_charge":28924.89,"discounted_cash":11569.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERTUZUMAB PER 1 MG INJ","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"6360001500","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"50242014501A","type":"NDC"}],"standard_charges":[{"gross_charge":30996.46,"discounted_cash":12398.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Colistimethate Sodium 150mg","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"6360001501","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0770","type":"HCPCS"},{"code":"6332339306","type":"NDC"}],"standard_charges":[{"gross_charge":158.75,"discounted_cash":63.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Humate P 500u vial","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"6360001502","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833061502A","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":31.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEGARELIX ACETATE 120MG VIAL","drug_information":{"unit":"240","type":"ME"},"code_information":[{"code":"6360001511","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9155","type":"HCPCS"},{"code":"55566840301J","type":"NDC"}],"standard_charges":[{"gross_charge":3805.12,"discounted_cash":1522.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETUXIMAB 200MG/100ML VIAL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360001512","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823A","type":"NDC"}],"standard_charges":[{"gross_charge":6780.47,"discounted_cash":2712.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cefiderocol 1g vial","drug_information":{"unit":"11.2","type":"ML"},"code_information":[{"code":"6360001515","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0699","type":"HCPCS"},{"code":"59630026610A","type":"NDC"}],"standard_charges":[{"gross_charge":900.61,"discounted_cash":360.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Fluorouracil 2.5g/50ml vial","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360001598","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021598","type":"NDC"}],"standard_charges":[{"gross_charge":149.17,"discounted_cash":59.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cyclophosphamide 50mg cap","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"6360001707","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"69097051707A","type":"NDC"}],"standard_charges":[{"gross_charge":84.24,"discounted_cash":33.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE 234MG SYR","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"6360001803","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458056401A","type":"NDC"}],"standard_charges":[{"gross_charge":11132.88,"discounted_cash":4453.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE 156MG SYR","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360001804","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458056301B","type":"NDC"}],"standard_charges":[{"gross_charge":9937.28,"discounted_cash":3974.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR OINT","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360001805","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578008201A","type":"NDC"}],"standard_charges":[{"gross_charge":258.48,"discounted_cash":103.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLIC"}]},{"description":"HYALURONATE SOD 4MG/0,4ML SYR","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"6360001809","type":"CDM"},{"code":"250","type":"RC"},{"code":"08065183004A","type":"NDC"}],"standard_charges":[{"gross_charge":657.46,"discounted_cash":262.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB INFLECTRA 100 mg","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360001880","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5103","type":"HCPCS"},{"code":"00069080901","type":"NDC"}],"standard_charges":[{"gross_charge":4719.16,"discounted_cash":1887.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIV AFLIBERCEPT PER MG/200","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360001994","type":"CDM"},{"code":"636","type":"RC"},{"code":"00024584001A","type":"NDC"}],"standard_charges":[{"gross_charge":2714.0,"discounted_cash":1085.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Docetaxel 20mg/2mL vial","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360002010","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"00409020102A","type":"NDC"}],"standard_charges":[{"gross_charge":378.53,"discounted_cash":151.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Doxorubicin Liosome 50mg vial","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"6360002050","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"72603020001A","type":"NDC"}],"standard_charges":[{"gross_charge":12081.46,"discounted_cash":4832.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-MVASI 100MG VIAL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360002060","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601A","type":"NDC"}],"standard_charges":[{"gross_charge":3384.9,"discounted_cash":1353.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-MVASI 400MG VIAL","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"6360002070","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701A","type":"NDC"}],"standard_charges":[{"gross_charge":13534.95,"discounted_cash":5413.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ilumya 100mg/mL syringe","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360002289","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3245","type":"HCPCS"},{"code":"47335017795A","type":"NDC"}],"standard_charges":[{"gross_charge":74311.53,"discounted_cash":29724.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Vancomycin 1.25gm Vial","drug_information":{"unit":"1.25","type":"GM"},"code_information":[{"code":"6360002399","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"55150047110A","type":"NDC"}],"standard_charges":[{"gross_charge":109.05,"discounted_cash":43.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Riabni 100mg/10ml vl","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360002401","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513022401A","type":"NDC"}],"standard_charges":[{"gross_charge":3574.71,"discounted_cash":1429.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Belatacept injection  1 MG","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"6360002402","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0485","type":"HCPCS"},{"code":"00003037113","type":"NDC"}],"standard_charges":[{"gross_charge":4718.84,"discounted_cash":1887.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Marcaine 0.5% 50ml MDV","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360002525","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00409116318A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Riabni 500mg/50ml vl","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360002601","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513032601A","type":"NDC"}],"standard_charges":[{"gross_charge":17873.57,"discounted_cash":7149.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Epinephrine 30mg/30ml vial","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"6360002951","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329906000A","type":"NDC"}],"standard_charges":[{"gross_charge":306.52,"discounted_cash":122.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Prevnar-20 Syringe","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360002986","type":"CDM"},{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200010A","type":"NDC"}],"standard_charges":[{"gross_charge":1241.15,"discounted_cash":496.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Romosozumab-AQQG 210mg/2.34ml","drug_information":{"unit":"2.34","type":"ML"},"code_information":[{"code":"6360003111","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802A","type":"NDC"}],"standard_charges":[{"gross_charge":9743.6,"discounted_cash":3897.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Omidria 1-0.3% vial","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360003350","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1097","type":"HCPCS"},{"code":"82604060004A","type":"NDC"}],"standard_charges":[{"gross_charge":8133.5,"discounted_cash":3253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Velcade 3.5mg vial","drug_information":{"unit":"3.5","type":"ME"},"code_information":[{"code":"6360003361","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"10019099101A","type":"NDC"}],"standard_charges":[{"gross_charge":5731.33,"discounted_cash":2292.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Bupivacaine 0.25% 50ml MDV","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360003490","type":"CDM"},{"code":"250","type":"RC"},{"code":"00409116001A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Zoladex 10.8mg implant","drug_information":{"unit":"10.8","type":"ME"},"code_information":[{"code":"6360003646","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9202","type":"HCPCS"},{"code":"70720095130B","type":"NDC"}],"standard_charges":[{"gross_charge":10956.79,"discounted_cash":4382.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Imipenem/Cilastatin/Relebactam","drug_information":{"unit":"1250","type":"ME"},"code_information":[{"code":"6360003706","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0742","type":"HCPCS"},{"code":"00006385602A","type":"NDC"}],"standard_charges":[{"gross_charge":1374.08,"discounted_cash":549.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAGARD LIQ 30GM/300ML-500MG","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"6360003709","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270007B","type":"NDC"}],"standard_charges":[{"gross_charge":21944.08,"discounted_cash":8777.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 150MG/100ML DEX BAG","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360004103","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"43066015010A","type":"NDC"}],"standard_charges":[{"gross_charge":197.58,"discounted_cash":79.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Alpha-1-Proteinase Inhibitor 1","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"6360004204","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0256","type":"HCPCS"},{"code":"13533070501B","type":"NDC"}],"standard_charges":[{"gross_charge":32.2,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cefazolin 3g/50mL PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360004324","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021010299A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOCYCLINE 100MG VL","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360004400","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2265","type":"HCPCS"},{"code":"70842016010C","type":"NDC"}],"standard_charges":[{"gross_charge":889.06,"discounted_cash":355.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 130MG/18ML VL","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"6360004401","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0185","type":"HCPCS"},{"code":"47426020101A","type":"NDC"}],"standard_charges":[{"gross_charge":1682.03,"discounted_cash":672.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 160MG/8ML VL","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"6360004402","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026765A","type":"NDC"}],"standard_charges":[{"gross_charge":12140.14,"discounted_cash":4856.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 2000MG/100ml","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360004740","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"44567062124A","type":"NDC"}],"standard_charges":[{"gross_charge":224.97,"discounted_cash":89.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 2000U VL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360005105","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130510A","type":"NDC"}],"standard_charges":[{"gross_charge":125.63,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 3000U VL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360005106","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130610A","type":"NDC"}],"standard_charges":[{"gross_charge":188.48,"discounted_cash":75.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 4000U VL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360005107","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130710A","type":"NDC"}],"standard_charges":[{"gross_charge":251.28,"discounted_cash":100.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 10,000U VL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360005108","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130810A","type":"NDC"}],"standard_charges":[{"gross_charge":623.87,"discounted_cash":249.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 40,000U VL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360005109","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130904A","type":"NDC"}],"standard_charges":[{"gross_charge":2200.29,"discounted_cash":880.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ontruzant 150mg vial","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"6360005110","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5112","type":"HCPCS"},{"code":"78206014701A","type":"NDC"}],"standard_charges":[{"gross_charge":6606.14,"discounted_cash":2642.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ontruzant 420mg vial","drug_information":{"unit":"420","type":"ME"},"code_information":[{"code":"6360005111","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5112","type":"HCPCS"},{"code":"78206014801A","type":"NDC"}],"standard_charges":[{"gross_charge":17017.39,"discounted_cash":6806.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HERZUMA 150MG VIAL","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"6360005113","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5113","type":"HCPCS"},{"code":"63459030343A","type":"NDC"}],"standard_charges":[{"gross_charge":7991.09,"discounted_cash":3196.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HERZUMA 420 MG VIAL","drug_information":{"unit":"420","type":"ME"},"code_information":[{"code":"6360005114","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5113","type":"HCPCS"},{"code":"63459030547A","type":"NDC"}],"standard_charges":[{"gross_charge":22373.42,"discounted_cash":8949.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Kanjinti 150mg SDV","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"6360005117","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513014101A","type":"NDC"}],"standard_charges":[{"gross_charge":6459.74,"discounted_cash":2583.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cosela 300mg vial","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"6360005227","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1448","type":"HCPCS"},{"code":"73462010101A","type":"NDC"}],"standard_charges":[{"gross_charge":6852.27,"discounted_cash":2740.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cangrelor Tetrasodium 50mg via","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"6360005273","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9460","type":"HCPCS"},{"code":"10122062010A","type":"NDC"}],"standard_charges":[{"gross_charge":3959.43,"discounted_cash":1583.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Releuko 300mcg/0.5ml syg","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360005303","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5125","type":"HCPCS"},{"code":"70121156801A","type":"NDC"}],"standard_charges":[{"gross_charge":782.28,"discounted_cash":312.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Releuko 480mcg/0.8ml syg","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"6360005304","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5125","type":"HCPCS"},{"code":"70121157001A","type":"NDC"}],"standard_charges":[{"gross_charge":1095.96,"discounted_cash":438.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cabenuva ER 400-600mg susp","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360005305","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0741","type":"HCPCS"},{"code":"49702025315A","type":"NDC"}],"standard_charges":[{"gross_charge":19498.73,"discounted_cash":7799.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cabenuva ER 600-900mg susp","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"6360005306","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0741","type":"HCPCS"},{"code":"49702024015A","type":"NDC"}],"standard_charges":[{"gross_charge":29248.12,"discounted_cash":11699.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRUXIMA 500MG/50ML VIAL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360005920","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450A","type":"NDC"}],"standard_charges":[{"gross_charge":21084.0,"discounted_cash":8433.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRUXIMA 100MG/10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360005921","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310A","type":"NDC"}],"standard_charges":[{"gross_charge":4216.8,"discounted_cash":1686.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed 100mg vial","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360006075","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"00002764001","type":"NDC"}],"standard_charges":[{"gross_charge":3085.07,"discounted_cash":1234.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cefazolin 2g vial","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"6360006231","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105A","type":"NDC"}],"standard_charges":[{"gross_charge":34.69,"discounted_cash":13.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Bivalirudin 250mg/50ml vial","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360006232","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"70860040351A","type":"NDC"}],"standard_charges":[{"gross_charge":875.22,"discounted_cash":350.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIPLOSTIM 125MCG/0.25ML INJ","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360006291","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2796","type":"HCPCS"},{"code":"55513022301A","type":"NDC"}],"standard_charges":[{"gross_charge":4058.64,"discounted_cash":1623.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"}]},{"description":"STELARA 130MG INJ","drug_information":{"unit":"26","type":"ML"},"code_information":[{"code":"6360006301","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3358","type":"HCPCS"},{"code":"57894005427B","type":"NDC"}],"standard_charges":[{"gross_charge":8370.25,"discounted_cash":3348.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZARXIO 480MCG SYR","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"6360006302","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601A","type":"NDC"}],"standard_charges":[{"gross_charge":2189.24,"discounted_cash":875.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZARXIO 300MCG SYR","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360006303","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031801A","type":"NDC"}],"standard_charges":[{"gross_charge":1142.58,"discounted_cash":457.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPHANATE ~1000U VIAL","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"6360006304","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7186","type":"HCPCS"},{"code":"68516461802A","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPHANATE ~2100U VIAL","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"6360006305","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7186","type":"HCPCS"},{"code":"68516462002A","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UDENYCA 6MG PFS 0.6ML","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"6360006307","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114010101B","type":"NDC"}],"standard_charges":[{"gross_charge":20853.46,"discounted_cash":8341.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Leqembi 500mg/5ml vial","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360006442","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0174","type":"HCPCS"},{"code":"62856021501A","type":"NDC"}],"standard_charges":[{"gross_charge":2881.48,"discounted_cash":1152.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tofidence 400mg/20ml vial","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360006525","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5133","type":"HCPCS"},{"code":"64406002301A","type":"NDC"}],"standard_charges":[{"gross_charge":9563.76,"discounted_cash":3825.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tofidence 200mg/10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360006526","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5133","type":"HCPCS"},{"code":"64406002201A","type":"NDC"}],"standard_charges":[{"gross_charge":4781.88,"discounted_cash":1912.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tofidence 80mg/4ml vial","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360006527","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5133","type":"HCPCS"},{"code":"64406002401A","type":"NDC"}],"standard_charges":[{"gross_charge":1912.75,"discounted_cash":765.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hydromorphone 0.5mg/0.5mL Syr","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360007048","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Factor VIII Xyntha 1000 units","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"6360007139","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7185","type":"HCPCS"},{"code":"58394001401A","type":"NDC"}],"standard_charges":[{"gross_charge":9071.15,"discounted_cash":3628.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Skyrizi 600mg/10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360007450","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2327","type":"HCPCS"},{"code":"00074501501","type":"NDC"}],"standard_charges":[{"gross_charge":43393.97,"discounted_cash":17357.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL PO","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360007452","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"00004026129","type":"NDC"}],"standard_charges":[{"gross_charge":35.54,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL PO","drug_information":{"unit":"360","type":"ME"},"code_information":[{"code":"6360007452","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"68084091825A","type":"NDC"}],"standard_charges":[{"gross_charge":35.54,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN 40MG/2ML VIAL","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360007502","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"59923071402A","type":"NDC"}],"standard_charges":[{"gross_charge":86.48,"discounted_cash":34.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMBROLIZUMAB 100MG/4ML VIAL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360007509","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302602A","type":"NDC"}],"standard_charges":[{"gross_charge":25136.55,"discounted_cash":10054.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDAL CONSTA 50MG/2ML","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360007510","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030811B","type":"NDC"}],"standard_charges":[{"gross_charge":4830.77,"discounted_cash":1932.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VYEPTI 100MG VIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360007570","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":7616.67,"discounted_cash":3046.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Gammagard 5g/50ml vial","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360008072","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004A","type":"NDC"}],"standard_charges":[{"gross_charge":3195.08,"discounted_cash":1278.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lurbinectedin 4mg vial","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"6360008652","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9223","type":"HCPCS"},{"code":"68727071201A","type":"NDC"}],"standard_charges":[{"gross_charge":35956.62,"discounted_cash":14382.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ado-Trastuzumab 160mg vial","drug_information":{"unit":"160","type":"ME"},"code_information":[{"code":"6360008701","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"50242008701A","type":"NDC"}],"standard_charges":[{"gross_charge":28036.6,"discounted_cash":11214.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ado-Trastuzumab 100mg vial","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360008801","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"50242008801A","type":"NDC"}],"standard_charges":[{"gross_charge":17522.91,"discounted_cash":7009.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMUCIRUMAB 500MG INJ-5MG","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360008816","type":"CDM"},{"code":"636","type":"RC"},{"code":"00002767801A","type":"NDC"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Belrapzo 100mg/4ml vial","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360008822","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9036","type":"HCPCS"},{"code":"42367052125A","type":"NDC"}],"standard_charges":[{"gross_charge":12957.4,"discounted_cash":5182.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Avelumab 200mg/10mL vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360009023","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9023","type":"HCPCS"},{"code":"44087353501A","type":"NDC"}],"standard_charges":[{"gross_charge":8497.53,"discounted_cash":3399.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cyclophosphamd IV nos 500","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"6360009070","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"81298811001A","type":"NDC"}],"standard_charges":[{"gross_charge":1820.27,"discounted_cash":728.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cyclophosphamde IV nos 1G","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"6360009071","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"81298811201A","type":"NDC"}],"standard_charges":[{"gross_charge":3640.54,"discounted_cash":1456.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Zynrelef 400mg/12mg","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"6360009080","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030102A","type":"NDC"}],"standard_charges":[{"gross_charge":1333.99,"discounted_cash":533.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Zynrelef 200mg/6mg","drug_information":{"unit":"7","type":"ML"},"code_information":[{"code":"6360009081","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030301A","type":"NDC"}],"standard_charges":[{"gross_charge":771.7,"discounted_cash":308.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Dacarbazine 100mg vial","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360009130","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"63323012710","type":"NDC"}],"standard_charges":[{"gross_charge":538.23,"discounted_cash":215.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARZALEX FASPRO 1,800MG VIAL","drug_information":{"unit":"1800","type":"ME"},"code_information":[{"code":"6360009144","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301A","type":"NDC"}],"standard_charges":[{"gross_charge":32987.45,"discounted_cash":13194.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Enfortumab Vedotin-EJFV 30mg v","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"6360009177","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"51144003001A","type":"NDC"}],"standard_charges":[{"gross_charge":18886.67,"discounted_cash":7554.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Enfortumab Vedotin-EJFV 20mg v","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"6360009178","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"51144002001A","type":"NDC"}],"standard_charges":[{"gross_charge":12591.12,"discounted_cash":5036.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Fluorouracil 1g/20mL vial","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360009190","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720A","type":"NDC"}],"standard_charges":[{"gross_charge":130.89,"discounted_cash":52.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Goserelin Acetate 3.6mg syr","drug_information":{"unit":"3.6","type":"ME"},"code_information":[{"code":"6360009202","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9202","type":"HCPCS"},{"code":"70720095036","type":"NDC"}],"standard_charges":[{"gross_charge":4090.29,"discounted_cash":1636.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ipilimumab 200 MG/40 ML VIAL","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"6360009228","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232822A","type":"NDC"}],"standard_charges":[{"gross_charge":135662.59,"discounted_cash":54265.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Obinutuzumab 1000mg/40ml SDV","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"6360009301","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001A","type":"NDC"}],"standard_charges":[{"gross_charge":36409.28,"discounted_cash":14563.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Vancomycin 1.5gm Vial","drug_information":{"unit":"1.5","type":"GM"},"code_information":[{"code":"6360009351","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"00409351501A","type":"NDC"}],"standard_charges":[{"gross_charge":132.1,"discounted_cash":52.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Retacrit 20,000 UNITS","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360009503","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131110A","type":"NDC"}],"standard_charges":[{"gross_charge":1100.14,"discounted_cash":440.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIATRIZOATE MEG SOD 120ML GAST","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"6360009963","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044540A","type":"NDC"}],"standard_charges":[{"gross_charge":396.88,"discounted_cash":158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BELIMUMAB 120MG VIAL","drug_information":{"unit":"120","type":"ME"},"code_information":[{"code":"6360010101","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401010101","type":"NDC"}],"standard_charges":[{"gross_charge":2702.4,"discounted_cash":1080.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BELIMUMAB 400MG VIAL","drug_information":{"unit":"400","type":"ME"},"code_information":[{"code":"6360010102","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401010201","type":"NDC"}],"standard_charges":[{"gross_charge":9007.65,"discounted_cash":3603.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GOLIMUMAB 50MG/4ML VL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360010593","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001A","type":"NDC"}],"standard_charges":[{"gross_charge":8261.97,"discounted_cash":3304.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 1500MG100ML IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360010710","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457026610A","type":"NDC"}],"standard_charges":[{"gross_charge":422.85,"discounted_cash":169.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INJECTAFER 750MG/15ML VL","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"6360010711","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"00517065001A","type":"NDC"}],"standard_charges":[{"gross_charge":6396.94,"discounted_cash":2558.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXRAZOXANE 250MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360010771","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"00143924701A","type":"NDC"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXRAZOXANE 500MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360010772","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"72611071601A","type":"NDC"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOCILIZUMAB 80MG/4ML VL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360010817","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501A","type":"NDC"}],"standard_charges":[{"gross_charge":2299.82,"discounted_cash":919.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM-JMDB 6MG0.6ML SY","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"6360011100","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541A","type":"NDC"}],"standard_charges":[{"gross_charge":17392.16,"discounted_cash":6956.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULF 4MG/ML VIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360011165","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"63323045401A","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB RENFLEXIS 100 MG","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360011352","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016201A","type":"NDC"}],"standard_charges":[{"gross_charge":3757.19,"discounted_cash":1502.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM GLYCEROPHOSPHATE 20ML V","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360011442","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323024120A","type":"NDC"}],"standard_charges":[{"gross_charge":74.05,"discounted_cash":29.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1G 50ML IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360011454","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310311A","type":"NDC"}],"standard_charges":[{"gross_charge":64.64,"discounted_cash":25.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIMETHYL SULFOXIDE 50ML VIAL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360011459","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1212","type":"HCPCS"},{"code":"67457017750A","type":"NDC"}],"standard_charges":[{"gross_charge":2845.45,"discounted_cash":1138.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20UNITS/100ML BAG","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360011460","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2601","type":"HCPCS"},{"code":"00338964012A","type":"NDC"}],"standard_charges":[{"gross_charge":714.25,"discounted_cash":285.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500MG/100ML PB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360011711","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789011005A","type":"NDC"}],"standard_charges":[{"gross_charge":66.44,"discounted_cash":26.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1G/50ML PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360011712","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00264318511A","type":"NDC"}],"standard_charges":[{"gross_charge":127.34,"discounted_cash":50.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 50MG/10ML VL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360011713","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00409321312A","type":"NDC"}],"standard_charges":[{"gross_charge":189.42,"discounted_cash":75.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTOLOZANE/TAZOBACTAM 75MG","drug_information":{"unit":"1.5","type":"GM"},"code_information":[{"code":"6360012001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0695","type":"HCPCS"},{"code":"67919003001A","type":"NDC"}],"standard_charges":[{"gross_charge":624.76,"discounted_cash":249.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN INJ 5G","drug_information":{"unit":"5000","type":"ME"},"code_information":[{"code":"6360012097","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323029561A","type":"NDC"}],"standard_charges":[{"gross_charge":408.64,"discounted_cash":163.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN INJ 10G","drug_information":{"unit":"10000","type":"ME"},"code_information":[{"code":"6360012098","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323031461A","type":"NDC"}],"standard_charges":[{"gross_charge":246.96,"discounted_cash":98.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN 4MCG/ML 10 ML VL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360012101","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566230000E","type":"NDC"}],"standard_charges":[{"gross_charge":2968.3,"discounted_cash":1187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE 1% 50ML VIAL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360012260","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323028357A","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOCILIZUMAB 400MG/20ML VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360012261","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":11573.89,"discounted_cash":4629.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 20MG/10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360012484","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604610F","type":"NDC"}],"standard_charges":[{"gross_charge":60.66,"discounted_cash":24.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE 0.5% 30ML VIAL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"6360012494","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028620A","type":"NDC"}],"standard_charges":[{"gross_charge":82.49,"discounted_cash":33.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN SODIUM 2G/50ML PB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360012506","type":"CDM"},{"code":"636","type":"RC"},{"code":"00264312511A","type":"NDC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEASLES,MUMPS,RUBELLA VAC 0.5","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360012507","type":"CDM"},{"code":"636","type":"RC"},{"code":"90707","type":"HCPCS"},{"code":"00006468100","type":"NDC"}],"standard_charges":[{"gross_charge":467.73,"discounted_cash":187.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VEDOLIZUMAB 300ML VIAL","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"6360012510","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3380","type":"HCPCS"},{"code":"64764030020B","type":"NDC"}],"standard_charges":[{"gross_charge":35595.03,"discounted_cash":14238.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 5MG/0.4ML SYR","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"6360012514","type":"CDM"},{"code":"636","type":"RC"},{"code":"67457059304","type":"NDC"}],"standard_charges":[{"gross_charge":643.64,"discounted_cash":257.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEMIN 350MG VIAL","drug_information":{"unit":"350","type":"ME"},"code_information":[{"code":"6360012597","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1640","type":"HCPCS"},{"code":"55292070255A","type":"NDC"}],"standard_charges":[{"gross_charge":46820.94,"discounted_cash":18728.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME/AVIBACTAM 0.5G/0.1","drug_information":{"unit":"2.5","type":"GM"},"code_information":[{"code":"6360012766","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0714","type":"HCPCS"},{"code":"00456270010A","type":"NDC"}],"standard_charges":[{"gross_charge":1789.4,"discounted_cash":715.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULF 80MG/100ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360013047","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050348A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB 240MG/24ML VIAL","drug_information":{"unit":"24","type":"ML"},"code_information":[{"code":"6360013072","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003373413A","type":"NDC"}],"standard_charges":[{"gross_charge":34388.89,"discounted_cash":13755.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 40MG CAP","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"6360013097","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"00781232151A","type":"NDC"}],"standard_charges":[{"gross_charge":521.8,"discounted_cash":208.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Gemcitabine 200mg vial","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"6360013107","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"16714090901A","type":"NDC"}],"standard_charges":[{"gross_charge":60.7,"discounted_cash":24.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Tocilizumab 200mg/10ml vial","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360022707","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":5749.57,"discounted_cash":2299.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXPAREL 1.3% 10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360030382","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250013309A","type":"NDC"}],"standard_charges":[{"gross_charge":926.11,"discounted_cash":370.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Vyvgart 400mg/20ml vial","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"636003475","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9332","type":"HCPCS"},{"code":"73475304105A","type":"NDC"}],"standard_charges":[{"gross_charge":29672.94,"discounted_cash":11869.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDVAXHIB 0.5ML VIAL","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360040001","type":"CDM"},{"code":"636","type":"RC"},{"code":"90647","type":"HCPCS"},{"code":"00006489700A","type":"NDC"}],"standard_charges":[{"gross_charge":150.5,"discounted_cash":60.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Isavuconazonium 372mg vial","drug_information":{"unit":"372","type":"ME"},"code_information":[{"code":"6360042001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1833","type":"HCPCS"},{"code":"00469042001A","type":"NDC"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":679.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB-AVSOLA 100MG VIAL","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360051016","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q5121","type":"HCPCS"},{"code":"55513067001A","type":"NDC"}],"standard_charges":[{"gross_charge":2146.47,"discounted_cash":858.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Carboplatin 600mg/60ml vial","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"6360051025","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033956A","type":"NDC"}],"standard_charges":[{"gross_charge":333.43,"discounted_cash":133.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Pemfexy 500mg/20ml vial","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"6360051074","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9304","type":"HCPCS"},{"code":"42367053133A","type":"NDC"}],"standard_charges":[{"gross_charge":19186.67,"discounted_cash":7674.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Leqvio 284mg/1.5mL Syg","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"6360057077","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060A","type":"NDC"}],"standard_charges":[{"gross_charge":13506.59,"discounted_cash":5402.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE UP TO 25 MG UNITS","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360087406","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517560125","type":"NDC"}],"standard_charges":[{"gross_charge":126.72,"discounted_cash":50.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IFOSFAMIDE 1GM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"6360087407","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"63323014210","type":"NDC"}],"standard_charges":[{"gross_charge":588.07,"discounted_cash":235.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINCRISTINE 1MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360087408","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":148.18,"discounted_cash":59.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINCRISTINE 2MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360087409","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030916","type":"NDC"}],"standard_charges":[{"gross_charge":50.69,"discounted_cash":20.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINCRISTINE 5MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087410","type":"CDM"},{"code":"636","type":"RC"},{"code":"61703030906A","type":"NDC"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 20MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360087411","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"00955102001A","type":"NDC"}],"standard_charges":[{"gross_charge":1230.56,"discounted_cash":492.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE 100MG I","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360087412","type":"CDM"},{"code":"636","type":"RC"},{"code":"61703030538A","type":"NDC"}],"standard_charges":[{"gross_charge":137.43,"discounted_cash":54.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN 10MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087413","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"00069303020A","type":"NDC"}],"standard_charges":[{"gross_charge":248.89,"discounted_cash":99.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN 50MG I","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"6360087514","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"63323088330A","type":"NDC"}],"standard_charges":[{"gross_charge":222.87,"discounted_cash":89.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESNA 1000MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087515","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"10019095301A","type":"NDC"}],"standard_charges":[{"gross_charge":689.94,"discounted_cash":275.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 500MG I","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"6360087516","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011408A","type":"NDC"}],"standard_charges":[{"gross_charge":1129.0,"discounted_cash":451.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAMPTOSAR 100MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087517","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00009011205A","type":"NDC"}],"standard_charges":[{"gross_charge":177.19,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN 200MG I","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360087518","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"70860020851A","type":"NDC"}],"standard_charges":[{"gross_charge":5166.48,"discounted_cash":2066.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN 20MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087519","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"00069303120A","type":"NDC"}],"standard_charges":[{"gross_charge":248.89,"discounted_cash":99.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 50MG I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360087520","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"44567050901A","type":"NDC"}],"standard_charges":[{"gross_charge":66.9,"discounted_cash":26.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 80MG I","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"6360087521","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026764A","type":"NDC"}],"standard_charges":[{"gross_charge":3931.29,"discounted_cash":1572.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"6360087522","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030436A","type":"NDC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB 500MG I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360087523","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":7964.46,"discounted_cash":3185.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GANCICLOVIR 500MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087524","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"25021018511A","type":"NDC"}],"standard_charges":[{"gross_charge":341.73,"discounted_cash":136.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B NEONATAL I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360087525","type":"CDM"},{"code":"636","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"13533063603","type":"NDC"}],"standard_charges":[{"gross_charge":673.74,"discounted_cash":269.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN 20MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360087526","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00009752910A","type":"NDC"}],"standard_charges":[{"gross_charge":118.66,"discounted_cash":47.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 20MG I","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"6360087528","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"16729010811A","type":"NDC"}],"standard_charges":[{"gross_charge":731.62,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 40MG I","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"6360087529","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"16729011638A","type":"NDC"}],"standard_charges":[{"gross_charge":5252.87,"discounted_cash":2101.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 5MG I","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"6360087530","type":"CDM"},{"code":"636","type":"RC"},{"code":"16729011505A","type":"NDC"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 30MG I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087531","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"63323076305A","type":"NDC"}],"standard_charges":[{"gross_charge":670.27,"discounted_cash":268.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DRONABINOL 2.5MG C","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"6360087532","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0167","type":"HCPCS"},{"code":"42858086706A","type":"NDC"}],"standard_charges":[{"gross_charge":24.45,"discounted_cash":9.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASPOFUNGIN 70 MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087535","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0637","type":"HCPCS"},{"code":"00006382310","type":"NDC"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE 1GM/30ML I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360087536","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030346A","type":"NDC"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE 2GM/50ML I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360087537","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703031922A","type":"NDC"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM 6MG I","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"6360087539","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":7612.54,"discounted_cash":3045.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN 200 MCG/ML I","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"6360087540","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"gross_charge":2707.69,"discounted_cash":1083.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BOTULINUM TOXIN TYPE A 100 U I","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"6360087541","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0585","type":"HCPCS"},{"code":"00023114501","type":"NDC"}],"standard_charges":[{"gross_charge":2591.94,"discounted_cash":1036.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE 100MG L","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360087542","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"00172731320","type":"NDC"}],"standard_charges":[{"gross_charge":974.73,"discounted_cash":389.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN 100MCG I","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"6360087543","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"gross_charge":1463.24,"discounted_cash":585.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 900MG/18ML I","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"6360087544","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015318A","type":"NDC"}],"standard_charges":[{"gross_charge":46.37,"discounted_cash":18.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 900MG/18ML I","drug_information":{"unit":"900","type":"ME"},"code_information":[{"code":"6360087544","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015318","type":"NDC"}],"standard_charges":[{"gross_charge":46.37,"discounted_cash":18.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087545","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"43598026202A","type":"NDC"}],"standard_charges":[{"gross_charge":10326.88,"discounted_cash":4130.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINBLASTINE 10MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087546","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":204.42,"discounted_cash":81.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPIRUBICIN 50MG I","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"6360087548","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9178","type":"HCPCS"},{"code":"00009509101A","type":"NDC"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":529.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPECITABINE 500MG T","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"6360087549","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8522","type":"HCPCS"},{"code":"62756023920A","type":"NDC"}],"standard_charges":[{"gross_charge":148.18,"discounted_cash":59.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE 20 MG I","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"6360087551","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"43598084858A","type":"NDC"}],"standard_charges":[{"gross_charge":223.08,"discounted_cash":89.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACARBAZINE 200MG I","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"6360087552","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"63323012820A","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40MG I","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"6360087553","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"72603012810A","type":"NDC"}],"standard_charges":[{"gross_charge":31.05,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUDARABINE 50MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360087558","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9185","type":"HCPCS"},{"code":"63323019202A","type":"NDC"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE LA 25 MG I","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"6360087559","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030611","type":"NDC"}],"standard_charges":[{"gross_charge":834.65,"discounted_cash":333.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBULIN 20GRAM I","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"6360087560","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043820A","type":"NDC"}],"standard_charges":[{"gross_charge":4962.74,"discounted_cash":1985.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN LIPOSOMAL 20MG/10M","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087561","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"72603010301A","type":"NDC"}],"standard_charges":[{"gross_charge":4832.45,"discounted_cash":1932.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 150MG I","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"6360087562","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033922A","type":"NDC"}],"standard_charges":[{"gross_charge":117.08,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL PROTEIN BOUND 100MG","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360087563","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9264","type":"HCPCS"},{"code":"68817013450","type":"NDC"}],"standard_charges":[{"gross_charge":2329.14,"discounted_cash":931.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAMIDRONATE 90 MG I","drug_information":{"unit":"90","type":"ME"},"code_information":[{"code":"6360087564","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032618A","type":"NDC"}],"standard_charges":[{"gross_charge":170.16,"discounted_cash":68.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMETREXED DISODIUM 500MG I","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"6360087565","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"00002762301","type":"NDC"}],"standard_charges":[{"gross_charge":16303.48,"discounted_cash":6521.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON 0.25MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087566","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"60505619301A","type":"NDC"}],"standard_charges":[{"gross_charge":206.76,"discounted_cash":82.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDARUBICIN 20MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360087567","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"00013259691A","type":"NDC"}],"standard_charges":[{"gross_charge":3333.0,"discounted_cash":1333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID PER MG/4","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087568","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021080166A","type":"NDC"}],"standard_charges":[{"gross_charge":854.33,"discounted_cash":341.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 50MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087569","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"63323075010A","type":"NDC"}],"standard_charges":[{"gross_charge":427.16,"discounted_cash":170.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 100MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360087570","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00781331780A","type":"NDC"}],"standard_charges":[{"gross_charge":472.41,"discounted_cash":188.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BLEOMYCIN 30 UNITS I","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"6360087571","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"16714090801A","type":"NDC"}],"standard_charges":[{"gross_charge":347.56,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BLEOMYCIN 30 UNITS I","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"6360087571","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"63323013720","type":"NDC"}],"standard_charges":[{"gross_charge":347.56,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE 30MG I","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"6360087574","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9218","type":"HCPCS"},{"code":"62935030330A","type":"NDC"}],"standard_charges":[{"gross_charge":8198.7,"discounted_cash":3279.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250MG I","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"6360087576","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"55111065237A","type":"NDC"}],"standard_charges":[{"gross_charge":1558.45,"discounted_cash":623.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM/CILASATIN 250MG I","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"6360087577","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323034925B","type":"NDC"}],"standard_charges":[{"gross_charge":133.13,"discounted_cash":53.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100MG I","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360087581","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"59572010201","type":"NDC"}],"standard_charges":[{"gross_charge":1463.24,"discounted_cash":585.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPOTECAN DSG PER 0.1 MG UN","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"6360087582","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"16729015131A","type":"NDC"}],"standard_charges":[{"gross_charge":664.48,"discounted_cash":265.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETUXIMAB 100MG I","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360087585","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823A","type":"NDC"}],"standard_charges":[{"gross_charge":2429.69,"discounted_cash":971.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA 25MCG/ML I","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"6360087586","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513005704A","type":"NDC"}],"standard_charges":[{"gross_charge":531.35,"discounted_cash":212.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA 60MCG/ML I","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"6360087587","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002304A","type":"NDC"}],"standard_charges":[{"gross_charge":1016.4,"discounted_cash":406.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN 150MCG I","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"6360087589","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"gross_charge":2031.63,"discounted_cash":812.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN 300MCG/0.6ML I","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"6360087591","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":2944.0,"discounted_cash":1177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN 500MCG/1ML I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360087592","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":4906.0,"discounted_cash":1962.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Menacwyd/menacwycrm vacc im","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360087593","type":"CDM"},{"code":"636","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"58160095509A","type":"NDC"}],"standard_charges":[{"gross_charge":606.23,"discounted_cash":242.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 VIAL"}]},{"description":"RITUXIMAB 100MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360087594","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"gross_charge":1594.05,"discounted_cash":637.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE 22.5MG I","drug_information":{"unit":"22.5","type":"ME"},"code_information":[{"code":"6360087596","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"62935022305A","type":"NDC"}],"standard_charges":[{"gross_charge":3152.24,"discounted_cash":1260.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARGATROBAN 100MG/ML I","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"6360087597","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323052603A","type":"NDC"}],"standard_charges":[{"gross_charge":6550.49,"discounted_cash":2620.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANITUMUMAB 100MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087598","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":6018.26,"discounted_cash":2407.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Humate-P ~2000U","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"6360087600","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833061702A","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":31.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Humate-P ~ 1000U","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"6360087601","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833061602A","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":31.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADALIMUMAB 40MG I","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"6360087602","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0135","type":"HCPCS"},{"code":"00074379902","type":"NDC"}],"standard_charges":[{"gross_charge":3860.68,"discounted_cash":1544.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM 1GM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"6360087603","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022110A","type":"NDC"}],"standard_charges":[{"gross_charge":666.77,"discounted_cash":266.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM 1GM I","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"6360087603","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022110B","type":"NDC"}],"standard_charges":[{"gross_charge":666.77,"discounted_cash":266.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 5MG/100ML PB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360087604","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"66758015546","type":"NDC"}],"standard_charges":[{"gross_charge":4791.5,"discounted_cash":1916.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE PER ML","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"6360087611","type":"CDM"},{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131695A","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBOPOETIN 40MCG/ML I","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"6360087612","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002104A","type":"NDC"}],"standard_charges":[{"gross_charge":731.62,"discounted_cash":292.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE 30MG KIT","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"6360087613","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"00078082581A","type":"NDC"}],"standard_charges":[{"gross_charge":6921.0,"discounted_cash":2768.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE 20MG KIT","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"6360087614","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"00078081881A","type":"NDC"}],"standard_charges":[{"gross_charge":4256.0,"discounted_cash":1702.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBANDRONATE 3MG/3ML KIT","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"6360087615","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"25021082761A","type":"NDC"}],"standard_charges":[{"gross_charge":1246.76,"discounted_cash":498.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ABATACEPT 250 MG I","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"6360087616","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0129","type":"HCPCS"},{"code":"00003218713A","type":"NDC"}],"standard_charges":[{"gross_charge":5324.51,"discounted_cash":2129.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 125MG C","drug_information":{"unit":"125","type":"ME"},"code_information":[{"code":"6360087617","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"00781232368A","type":"NDC"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":155.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 80MG C","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"6360087618","type":"CDM"},{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"68462058458A","type":"NDC"}],"standard_charges":[{"gross_charge":390.12,"discounted_cash":156.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORICONAZOLE 200MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360087620","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"00049319028","type":"NDC"}],"standard_charges":[{"gross_charge":708.09,"discounted_cash":283.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RASBURICASE 1.5MG I","drug_information":{"unit":"1.5","type":"ME"},"code_information":[{"code":"6360087621","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"00024515010","type":"NDC"}],"standard_charges":[{"gross_charge":1379.89,"discounted_cash":551.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 400MG IVPB","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"6360087622","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"00409432124A","type":"NDC"}],"standard_charges":[{"gross_charge":33.13,"discounted_cash":13.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 100MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360087624","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":227.82,"discounted_cash":91.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IXABEPILONE 45MG I","drug_information":{"unit":"45","type":"ME"},"code_information":[{"code":"6360087625","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020191101A","type":"NDC"}],"standard_charges":[{"gross_charge":5864.0,"discounted_cash":2345.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 750MG IVPB","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"6360087626","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043724A","type":"NDC"}],"standard_charges":[{"gross_charge":61.3,"discounted_cash":24.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 0.83MG/ML 180ML","drug_information":{"unit":"180","type":"ML"},"code_information":[{"code":"6360087627","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230850A","type":"NDC"}],"standard_charges":[{"gross_charge":1097.43,"discounted_cash":438.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIGECYCLINE 50MG VIAL","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"6360087631","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"70121164707A","type":"NDC"}],"standard_charges":[{"gross_charge":592.33,"discounted_cash":236.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIGECYCLINE 50MG VIAL","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"6360087631","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"70121164707B","type":"NDC"}],"standard_charges":[{"gross_charge":592.33,"discounted_cash":236.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERUMOXYTOL 510MG/17ML I","drug_information":{"unit":"17","type":"ML"},"code_information":[{"code":"6360089631","type":"CDM"},{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":4880.03,"discounted_cash":1952.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOXANTRONE 20MG I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360089632","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9293","type":"HCPCS"},{"code":"63323013210","type":"NDC"}],"standard_charges":[{"gross_charge":3711.35,"discounted_cash":1484.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 40MG/10ML I","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360089633","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604825A","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENDAMUSTINE 100MG I","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360089634","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"63459039120","type":"NDC"}],"standard_charges":[{"gross_charge":3664.0,"discounted_cash":1465.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 2gms, INJ","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"6360089635","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"00009085001","type":"NDC"}],"standard_charges":[{"gross_charge":197.96,"discounted_cash":79.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE 200MG I","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360089636","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00143965901A","type":"NDC"}],"standard_charges":[{"gross_charge":102.52,"discounted_cash":41.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMOZOLOMIDE 100MG I","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360089637","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9328","type":"HCPCS"},{"code":"00085138101","type":"NDC"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 1MG C","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"6360089638","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084045001A","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4MG/5ML I","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360089639","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00641625301A","type":"NDC"}],"standard_charges":[{"gross_charge":1056.64,"discounted_cash":422.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEP B ADULT (3 DOSE) 20 MCG 1","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360089640","type":"CDM"},{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"gross_charge":232.68,"discounted_cash":93.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN 100MG","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"6360089642","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"60505612000A","type":"NDC"}],"standard_charges":[{"gross_charge":894.21,"discounted_cash":357.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE 45 MG INJ","drug_information":{"unit":"45","type":"ME"},"code_information":[{"code":"6360089643","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"62935045345A","type":"NDC"}],"standard_charges":[{"gross_charge":5019.0,"discounted_cash":2007.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLADRIBINE 1MG/1ML 10ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360089644","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010A","type":"NDC"}],"standard_charges":[{"gross_charge":1974.91,"discounted_cash":789.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IV IMMUNE GLOBULIN 5GRAM 50ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360089645","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043605","type":"NDC"}],"standard_charges":[{"gross_charge":1559.32,"discounted_cash":623.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSAPREPITANT DIMEGLUMINE 150M","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360089646","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"67457088910A","type":"NDC"}],"standard_charges":[{"gross_charge":389.58,"discounted_cash":155.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DENOSUMAB (XGEVA) 120 MG","drug_information":{"unit":"1.7","type":"ML"},"code_information":[{"code":"6360089647","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":10228.64,"discounted_cash":4091.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIPLOSTIM 250MCG 0.5ML SDV","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360089648","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2796","type":"HCPCS"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":2985.52,"discounted_cash":1194.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"MICAFUNGIN 50MG VIAL","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"6360089649","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"00469325010","type":"NDC"}],"standard_charges":[{"gross_charge":443.78,"discounted_cash":177.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN/TAZOBACTAM 3.375G","drug_information":{"unit":"3.375","type":"GM"},"code_information":[{"code":"6360089650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00409338513A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN/TAZOBACTAM 3.375G","drug_information":{"unit":"3.375","type":"GM"},"code_information":[{"code":"6360089650","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"70860012130A","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500MG INJ","drug_information":{"unit":"0.5","type":"GM"},"code_information":[{"code":"6360089653","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720A","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN/TAZOBACTAM 4.5GM","drug_information":{"unit":"4.5","type":"GM"},"code_information":[{"code":"6360089654","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00409339004A","type":"NDC"}],"standard_charges":[{"gross_charge":65.16,"discounted_cash":26.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CABAZITAXEL 60MG/1.5ML INJ","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"6360089655","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9276","type":"HCPCS"},{"code":"00024582411","type":"NDC"}],"standard_charges":[{"gross_charge":16282.0,"discounted_cash":6512.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME 1GM INJECTION","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"6360089658","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021012120A","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERZAINE 50MG/10ML VIA","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360089662","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"55390007701A","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE (VIMPAT) 200MG/20ML","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360089663","type":"CDM"},{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"00131181067","type":"NDC"}],"standard_charges":[{"gross_charge":370.82,"discounted_cash":148.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 500MG/100ML INJ","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360089664","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":52.22,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 250MG/50ML INJ","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"6360089665","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013281","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":13.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DENOSUMAB 60MG INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360089666","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021B","type":"NDC"}],"standard_charges":[{"gross_charge":5804.44,"discounted_cash":2321.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 1000MG","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"6360089667","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"65219062420A","type":"NDC"}],"standard_charges":[{"gross_charge":166.12,"discounted_cash":66.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE 25MG INJ","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"6360089669","type":"CDM"},{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"63323027205A","type":"NDC"}],"standard_charges":[{"gross_charge":255.83,"discounted_cash":102.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 100MG INJ","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"6360089670","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"00009000501A","type":"NDC"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 100MG/10ML INJ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"6360089671","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323051610A","type":"NDC"}],"standard_charges":[{"gross_charge":32.41,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE 25MG/ML INJ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"6360089674","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517420125A","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":12.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 1000MG IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"6360089675","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457026510","type":"NDC"}],"standard_charges":[{"gross_charge":160.61,"discounted_cash":64.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNORUBICIN 20MG INJ","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"6360089677","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9150","type":"HCPCS"},{"code":"42658002102A","type":"NDC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":59.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRENTUXIMAB 50MG INJ","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"6360089678","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9042","type":"HCPCS"},{"code":"51144005001A","type":"NDC"}],"standard_charges":[{"gross_charge":11239.38,"discounted_cash":4495.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOMEPIZOLE 1.5 G/1.5 ML","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"6360089681","type":"CDM"},{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"67457021102A","type":"NDC"}],"standard_charges":[{"gross_charge":3071.18,"discounted_cash":1228.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIV-AFLIBERCEPT 100MG VIAL","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"6360089692","type":"CDM"},{"code":"636","type":"RC"},{"code":"00024584101A","type":"NDC"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":542.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Cabotegravir 600 MG/3 ML","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"6360187611","type":"CDM"},{"code":"636","type":"RC"},{"code":"J0739","type":"HCPCS"},{"code":"49702026423A","type":"NDC"}],"standard_charges":[{"gross_charge":17763.62,"discounted_cash":7105.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Levonorgestrel 52MG System IUD","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6360187612","type":"CDM"},{"code":"636","type":"RC"},{"code":"J7297","type":"HCPCS"},{"code":"00023585801A","type":"NDC"}],"standard_charges":[{"gross_charge":4013.88,"discounted_cash":1605.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRETHRINS-PIPERONYL BUTOXIDE","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6370000001","type":"CDM"},{"code":"259","type":"RC"},{"code":"16500050492","type":"NDC"}],"standard_charges":[{"gross_charge":80.26,"discounted_cash":32.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DABIGATRAN 150MG CAP","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"6370000002","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597036082A","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOMETASONE FUROATE 110MCG INH","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6370000003","type":"CDM"},{"code":"259","type":"RC"},{"code":"78206011501A","type":"NDC"}],"standard_charges":[{"gross_charge":465.37,"discounted_cash":186.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"ZIPRASIDONE 80MG CAPSULE","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"6370000004","type":"CDM"},{"code":"259","type":"RC"},{"code":"68084010609A","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALGANCICLOVIR 450MG TAB","drug_information":{"unit":"450","type":"ME"},"code_information":[{"code":"6370000005","type":"CDM"},{"code":"259","type":"RC"},{"code":"65862075360B","type":"NDC"}],"standard_charges":[{"gross_charge":326.43,"discounted_cash":130.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVELAMER 0.8GRAM PACKET","drug_information":{"unit":"0.8","type":"GM"},"code_information":[{"code":"6370000006","type":"CDM"},{"code":"259","type":"RC"},{"code":"58468013202","type":"NDC"}],"standard_charges":[{"gross_charge":36.16,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DABIGATRAN ETEXILATE 75MG","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"6370000007","type":"CDM"},{"code":"259","type":"RC"},{"code":"00597035509A","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 137MCG TAB","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6370000008","type":"CDM"},{"code":"259","type":"RC"},{"code":"00527163810A","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 137 MCG"}]},{"description":"PROPAFENONE SR 225MG CAP","drug_information":{"unit":"225","type":"ME"},"code_information":[{"code":"6370000009","type":"CDM"},{"code":"259","type":"RC"},{"code":"69680013060A","type":"NDC"}],"standard_charges":[{"gross_charge":32.04,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UMECLIDINIUM BROMIDE INHALER","drug_information":{"unit":"1","type":"EA"},"code_information":[{"code":"6370002405","type":"CDM"},{"code":"259","type":"RC"},{"code":"00173087306A","type":"NDC"}],"standard_charges":[{"gross_charge":303.3,"discounted_cash":121.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"}]},{"description":"Lesion Removal Colonoscopy 45385","code_information":[{"code":"6408209","type":"CDM"},{"code":"45385","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Vaginal Hysterectomy 58260","code_information":[{"code":"6408210","type":"CDM"},{"code":"58260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.73,"discounted_cash":663.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Extensive Hysterectomy 58200","code_information":[{"code":"6408211","type":"CDM"},{"code":"58200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2747.61,"discounted_cash":1099.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Repair Of Vagina 57260","code_information":[{"code":"6408216","type":"CDM"},{"code":"57260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1676.27,"discounted_cash":670.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Vag Hyst Including T/O 58262","code_information":[{"code":"6408221","type":"CDM"},{"code":"58262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1853.5,"discounted_cash":741.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Neck Spine Fuse&Remov Bel C2 22551","code_information":[{"code":"6408266","type":"CDM"},{"code":"22551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3447.46,"discounted_cash":1378.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Diagnostic Laryngoscopy  (Except Newborn) 31525","code_information":[{"code":"6466423","type":"CDM"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.74,"discounted_cash":130.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Diagnostic Laryngoscopy   (With Operating Telescope) 31526","code_information":[{"code":"6466424","type":"CDM"},{"code":"31526","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.06,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Operative Laryngoscopy   (With Biopsy) 31535","code_information":[{"code":"6466425","type":"CDM"},{"code":"31535","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.59,"discounted_cash":155.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Operative Laryngoscopy   (With Biopsy And Telscope) 31536","code_information":[{"code":"6466426","type":"CDM"},{"code":"31536","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.79,"discounted_cash":172.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Operative Laryngoscopy   (With Exision Of Tumor) 31541","code_information":[{"code":"6466427","type":"CDM"},{"code":"31541","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.75,"discounted_cash":216.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Incision Of Windpipe   31603","code_information":[{"code":"6466428","type":"CDM"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.78,"discounted_cash":181.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Bladder Scan","code_information":[{"code":"651590","type":"CDM"},{"code":"920","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy W/Biopsy (Single Or Multiple) 44389","code_information":[{"code":"6540208","type":"CDM"},{"code":"44389","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.99,"discounted_cash":149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Change Perc Gastrostomy Tube W/O Image Guidance 43762","code_information":[{"code":"6573539","type":"CDM"},{"code":"510","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":403.2,"discounted_cash":161.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Nasotracheal - Rt Charge Suction","code_information":[{"code":"6690653","type":"CDM"},{"code":"761","type":"RC"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Manipulate Chest Pt Subsequent - Rt Charge Chest Physiotherapy","code_information":[{"code":"6690678","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":71.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Manipulate Chest Pt Initial - Rt Charge Chest Physiotherapy","code_information":[{"code":"6690679","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Daily Osa - Rt Charge Non-Invasive Management","code_information":[{"code":"6711088","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Life Support Initial Day - Rt Charge Non-Invasive Management","code_information":[{"code":"6711089","type":"CDM"},{"code":"410","type":"RC"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Life Support Subsequent Day - Rt Charge Non-Invasive Management","code_information":[{"code":"6711090","type":"CDM"},{"code":"410","type":"RC"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mra Abdomen W/ + W/O Contrast - Report","code_information":[{"code":"675660","type":"CDM"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trans Care Mgmt 7 Day Disch 99496","code_information":[{"code":"6822237","type":"CDM"},{"code":"510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":194.0,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Trans Care Mgmt 14 Day Disch 99495","code_information":[{"code":"6822238","type":"CDM"},{"code":"510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":224.1,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Polysomnography Sleep Staging 4/Greater Than Addl Param 95810","code_information":[{"code":"6873927","type":"CDM"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.87,"discounted_cash":480.35,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":247.16,"discounted_cash":98.86,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Electroencephelogram W/Rec Awake Plus Drowsy 95816","code_information":[{"code":"6873929","type":"CDM"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.88,"discounted_cash":276.75,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":116.32,"discounted_cash":46.53,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Xr Chest 2 Views","code_information":[{"code":"689607","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.59,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":31.59,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Intermediate Repair Neck/Hand/Feet/Genital, 12.6-20Cm 12045","code_information":[{"code":"6898171","type":"CDM"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.4,"discounted_cash":218.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Intubation, Et, Emergency 31500","code_information":[{"code":"6994896","type":"CDM"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Cord Abo/Rh","code_information":[{"code":"7032168","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cord Dat","code_information":[{"code":"7032169","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":35.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dat Igg","code_information":[{"code":"7032170","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":35.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88341 Ap Bill Immunoperoxidase, Additional","code_information":[{"code":"7034165","type":"CDM"},{"code":"300","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88112 Ap Bill Non-Gyn Cytology Thinprep","code_information":[{"code":"7034173","type":"CDM"},{"code":"310","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88305 Ap Bill Bone Marrow Biopsy","code_information":[{"code":"7034174","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Weak D","code_information":[{"code":"7034270","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":30.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"U Creatinine","code_information":[{"code":"7038212","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hemoglobin","code_information":[{"code":"7042219","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mch","code_information":[{"code":"7042226","type":"CDM"},{"code":"300","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mchc","code_information":[{"code":"7042227","type":"CDM"},{"code":"300","type":"RC"},{"code":"88738","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mean Platelet Volume","code_information":[{"code":"7042232","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Platelets","code_information":[{"code":"7042242","type":"CDM"},{"code":"300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Red Blood Cell","code_information":[{"code":"7042249","type":"CDM"},{"code":"300","type":"RC"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rdw","code_information":[{"code":"7042251","type":"CDM"},{"code":"300","type":"RC"},{"code":"78120","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"White Blood Cell","code_information":[{"code":"7042257","type":"CDM"},{"code":"300","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose Load","code_information":[{"code":"7049870","type":"CDM"},{"code":"300","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iron Lvl","code_information":[{"code":"7050169","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tibc","code_information":[{"code":"7050172","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osmolality Serum","code_information":[{"code":"7050232","type":"CDM"},{"code":"300","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osmolality (U)","code_information":[{"code":"7050234","type":"CDM"},{"code":"300","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ot Assisting Personnel Total Units","code_information":[{"code":"7136134","type":"CDM"},{"code":"431","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Attended E-Stim Units","code_information":[{"code":"7139395","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Rom Measure Extremity Trunk No Hands","code_information":[{"code":"7139396","type":"CDM"},{"code":"420","type":"RC"},{"code":"95851","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Whirlpool, Fluidotherapy Units","code_information":[{"code":"7139403","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Slp Evaluation Of Speech Fluency Units","code_information":[{"code":"7146947","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Fetal Heart Monitor External","code_information":[{"code":"715750","type":"CDM"},{"code":"920","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":241.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ecg 12 Lead","code_information":[{"code":"7252731","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.8,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Ecg Acquisition","code_information":[{"code":"7252741","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":78.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ecg Acquisition","code_information":[{"code":"7252742","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stress Acquisition","code_information":[{"code":"7254712","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0162 Rbc Cpd 450 Lr Irr","code_information":[{"code":"7266543","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0164 Rbc Cpd 450 Lr","code_information":[{"code":"7266544","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0179 Rbc Cpd 500 Lr Irr","code_information":[{"code":"7266547","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0181 Rbc Cpd 500 Lr","code_information":[{"code":"7266548","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0207 Rbc Cpda1 450 Lr Irr","code_information":[{"code":"7266551","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0209 Rbc Cpda1 450 Lr","code_information":[{"code":"7266552","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0224 Rbc Cpda1 500 Lr Irr","code_information":[{"code":"7266555","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0226 Rbc Cpda1 500 Lr","code_information":[{"code":"7266556","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0257 Rbc Cp2D 450 Lr Irr","code_information":[{"code":"7266560","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0259 Rbc Cp2D 450 Lr","code_information":[{"code":"7266561","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0273 Rbc Cp2D 500 Irr","code_information":[{"code":"7266563","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0274 Rbc Cp2D 500 Lr Irr","code_information":[{"code":"7266564","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0276 Rbc Cp2D 500 Lr","code_information":[{"code":"7266565","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0307 Rbc Cpd As1 450 Lr Irr","code_information":[{"code":"7266569","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0311 Rbc Cpd As1 450 Lr","code_information":[{"code":"7266570","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0332 Rbc Cpd As1 500 Lr Irr","code_information":[{"code":"7266573","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0336 Rbc Cpd As1 500 Lr","code_information":[{"code":"7266574","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0357 Rbc Cp2D As3 450 Lr Irr","code_information":[{"code":"7266577","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0361 Rbc Cp2D As3 450 Lr","code_information":[{"code":"7266578","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4272 Aph Rbc Cp2D Lr Irr","code_information":[{"code":"7266581","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4279 Aph Rbc Cp2D Lr Irr 1","code_information":[{"code":"7266582","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4280 Aph Rbc Cp2D Lr Irr 2","code_information":[{"code":"7266583","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4289 Aph Rbc Cp2D Lr","code_information":[{"code":"7266584","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4296 Aph Rbc Cp2D Lr 1","code_information":[{"code":"7266585","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4297 Aph Rbc Cp2D Lr 2","code_information":[{"code":"7266586","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4362 Aph Rbc Acda Lr Irr","code_information":[{"code":"7266587","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4369 Aph Rbc Acda Lr Irr 1","code_information":[{"code":"7266588","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4370 Aph Rbc Acda Lr Irr 2","code_information":[{"code":"7266589","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4379 Aph Rbc Acda Lr","code_information":[{"code":"7266590","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4386 Aph Rbc Acda Lr 1","code_information":[{"code":"7266591","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4387 Aph Rbc Acda Lr 2","code_information":[{"code":"7266592","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4519 Rbc Deglyc Lr","code_information":[{"code":"7266593","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4521 Rbc Deglyc Lr Irr","code_information":[{"code":"7266595","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4526 Aph Rbc Acda As1 Lr Irr","code_information":[{"code":"7266598","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4527 Aph Rbc Acda As1 Lr Irr 1","code_information":[{"code":"7266599","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4528 Aph Rbc Acda As1 Lr Irr 2","code_information":[{"code":"7266600","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4531 Aph Rbc Acda As1 Lr","code_information":[{"code":"7266601","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4532 Aph Rbc Acda As1 Lr 1","code_information":[{"code":"7266602","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4533 Aph Rbc Acda As1 Lr 2","code_information":[{"code":"7266603","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4538 Aph Rbc Acda As3 Lr Irr","code_information":[{"code":"7266608","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4539 Aph Rbc Acda As3 Lr Irr 1","code_information":[{"code":"7266609","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4540 Aph Rbc Acda As3 Lr Irr 2","code_information":[{"code":"7266610","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4543 Aph Rbc Acda As3 Lr","code_information":[{"code":"7266613","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4544 Aph Rbc Acda As3 Lr 1","code_information":[{"code":"7266614","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4545 Aph Rbc Acda As3 Lr 2","code_information":[{"code":"7266615","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4560 Aph Rbc Washed Lr Irr 1","code_information":[{"code":"7266618","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4561 Aph Rbc Washed Lr Irr 2","code_information":[{"code":"7266619","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4564 Aph Rbc Washed Lr 1","code_information":[{"code":"7266622","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4565 Aph Rbc Washed Lr 2","code_information":[{"code":"7266623","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4582 Aph Rbc Deglyc Lr Irr","code_information":[{"code":"7266628","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4583 Aph Rbc Deglyc Lr Irr 1","code_information":[{"code":"7266629","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4584 Aph Rbc Deglyc Lr Irr 2","code_information":[{"code":"7266630","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4587 Aph Rbc Deglyc Lr","code_information":[{"code":"7266633","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4588 Aph Rbc Deglyc Lr 1","code_information":[{"code":"7266634","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4589 Aph Rbc Deglyc Lr 2","code_information":[{"code":"7266635","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4633 Rbc Deglyc Rej Lr","code_information":[{"code":"7266638","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4634 Rbc Deglyc Rej Lr Irr","code_information":[{"code":"7266639","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5114 Aph Rbc Cpda1 Lr Irr","code_information":[{"code":"7266641","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5116 Aph Rbc Cpda1 Lr Irr 2","code_information":[{"code":"7266642","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5117 Aph Rbc Cpda1 Lr","code_information":[{"code":"7266643","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5118 Aph Rbc Cpda1 Lr 1","code_information":[{"code":"7266644","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5119 Aph Rbc Cpda1 Lr 2","code_information":[{"code":"7266645","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5155 Rbc Cpda1 Lr Lv","code_information":[{"code":"7266646","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5156 Rbc Cpda1 Lr Lv Acadj","code_information":[{"code":"7266647","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5169 Rbc Washed Lr","code_information":[{"code":"7266650","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5376 Rbc Cpda1 Lr Irr Lv","code_information":[{"code":"7266653","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5555 Rbc Cpda1 Lr Irr Lv Acadj","code_information":[{"code":"7266654","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6653 Aph Rbc Deglyc As3 Lr 1","code_information":[{"code":"7266655","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6655 Aph Rbc Deglyc As3 Lr Irr 1","code_information":[{"code":"7266656","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0379 Rbc Cp2D As3 500 Lr Irr","code_information":[{"code":"7266658","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0382 Rbc Cp2D As3 500 Lr","code_information":[{"code":"7266659","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0398 Rbc Cpd As5 450 Lr Irr","code_information":[{"code":"7266662","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0401 Rbc Cpd As5 450 Lr","code_information":[{"code":"7266663","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0420 Rbc Cpd As5 500 Lr Irr","code_information":[{"code":"7266666","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0424 Rbc Cpd As5 500 Lr","code_information":[{"code":"7266667","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0661 Aph Rbc Cp2D As3 Lr Irr","code_information":[{"code":"7266673","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0668 Aph Rbc Cp2D As3 Lr Irr 1","code_information":[{"code":"7266674","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0669 Aph Rbc Cp2D As3 Lr Irr 2","code_information":[{"code":"7266675","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0678 Aph Rbc Cp2D As3 Lr","code_information":[{"code":"7266678","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0685 Aph Rbc Cp2D As3 Lr 1","code_information":[{"code":"7266679","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0686 Aph Rbc Cp2D As3 Lr 2","code_information":[{"code":"7266680","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4144 Aph Rbc Washed Lr","code_information":[{"code":"7266685","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4145 Aph Rbc Washed Lr Irr","code_information":[{"code":"7266686","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5115 Aph Rbc Cpda1 Lr Irr 1","code_information":[{"code":"7266691","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5170 Rbc Washed Lr Irr","code_information":[{"code":"7266692","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6654 Aph Rbc Deglyc As3 Lr 2","code_information":[{"code":"7266693","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6656 Aph Rbc Deglyc As3 Lr Irr 2","code_information":[{"code":"7266694","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2940 Aph Plt Acda","code_information":[{"code":"7266759","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3045 Aph Plt Acda Irr","code_information":[{"code":"7266760","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3046 Aph Plt Acda Lr Irr","code_information":[{"code":"7266761","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3047 Aph Plt Acda Lr Irr Plasred","code_information":[{"code":"7266762","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3049 Aph Plt Acda Lr Irr Plasred 1","code_information":[{"code":"7266763","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3050 Aph Plt Acda Lr Irr Plasred 2","code_information":[{"code":"7266764","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3051 Aph Plt Acda Lr Irr Plasred 3","code_information":[{"code":"7266765","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3056 Aph Plt Acda Lr Irr 1","code_information":[{"code":"7266766","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3057 Aph Plt Acda Lr Irr 2","code_information":[{"code":"7266767","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3062 Aph Plt Acda Irr Plasred","code_information":[{"code":"7266768","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3064 Aph Plt Acda Irr Plasred 1","code_information":[{"code":"7266769","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3065 Aph Plt Acda Irr Plasred 2","code_information":[{"code":"7266770","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3066 Aph Plt Acda Irr Plasred 3","code_information":[{"code":"7266771","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3071 Aph Plt Acda Irr 1","code_information":[{"code":"7266772","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3072 Aph Plt Acda Irr 2","code_information":[{"code":"7266773","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3073 Aph Plt Acda Irr 3","code_information":[{"code":"7266774","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3077 Aph Plt Acda Lr","code_information":[{"code":"7266775","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3078 Aph Plt Acda Lr Plasred","code_information":[{"code":"7266776","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3080 Aph Plt Acda Lr Plasred 1","code_information":[{"code":"7266777","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3081 Aph Plt Acda Lr Plasred 2","code_information":[{"code":"7266778","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3082 Aph Plt Acda Lr Plasred 3","code_information":[{"code":"7266779","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3087 Aph Plt Acda Lr 1","code_information":[{"code":"7266780","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3088 Aph Plt Acda Lr 2","code_information":[{"code":"7266781","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3089 Aph Plt Acda Lr 3","code_information":[{"code":"7266782","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3093 Aph Plt Acda Plasred","code_information":[{"code":"7266783","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3095 Aph Plt Acda Plasred 1","code_information":[{"code":"7266784","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3096 Aph Plt Acda Plasred 2","code_information":[{"code":"7266785","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3097 Aph Plt Acda Plasred 3","code_information":[{"code":"7266786","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3102 Aph Plt Acda 1","code_information":[{"code":"7266787","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0201 Dv Rbc Cpda1 450 Lr Irr Open","code_information":[{"code":"7266788","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0203 Dv Rbc Cpda1 450 Lr Open","code_information":[{"code":"7266789","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0207 Dv Rbc Cpda1 450 Lr Irr","code_information":[{"code":"7266791","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0209 Dv Rbc Cpda1 450 Lr","code_information":[{"code":"7266792","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0218 Dv Rbc Cpda1 500 Lr Irr Open","code_information":[{"code":"7266796","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0220 Dv Rbc Cpda1 500 Lr Open","code_information":[{"code":"7266797","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0224 Dv Rbc Cpda1 500 Lr Irr","code_information":[{"code":"7266799","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0251 Dv Rbc Cp2D 450 Lr Irr Open","code_information":[{"code":"7266804","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0253 Dv Rbc Cp2D 450 Lr Open","code_information":[{"code":"7266805","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0257 Dv Rbc Cp2D 450 Lr Irr","code_information":[{"code":"7266807","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0259 Dv Rbc Cp2D 450 Lr","code_information":[{"code":"7266808","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0268 Dv Rbc Cp2D 500 Lr Irr Open","code_information":[{"code":"7266811","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0270 Dv Rbc Cp2D 500 Lr Open","code_information":[{"code":"7266812","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0274 Dv Rbc Cp2D 500 Lr Irr","code_information":[{"code":"7266814","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0276 Dv Rbc Cp2D 500 Lr","code_information":[{"code":"7266815","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0297 Dv Rbc Cpd As1 450 Lr Irr Open","code_information":[{"code":"7266820","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0301 Dv Rbc Cpd As1 450 Lr Open","code_information":[{"code":"7266821","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0307 Dv Rbc Cpd As1 450 Lr Irr","code_information":[{"code":"7266822","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0311 Dv Rbc Cpd As1 450 Lr","code_information":[{"code":"7266823","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0322 Dv Rbc Cpd As1 500 Lr Irr Open","code_information":[{"code":"7266827","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0326 Dv Rbc Cpd As1 500 Lr Open","code_information":[{"code":"7266828","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0332 Dv Rbc Cpd As1 500 Lr Irr","code_information":[{"code":"7266830","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0336 Dv Rbc Cpd As1 500 Lr","code_information":[{"code":"7266831","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0347 Dv Rbc Cp2D As3 450 Lr Irr Open","code_information":[{"code":"7266834","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0351 Dv Rbc Cp2D As3 450 Lr Open","code_information":[{"code":"7266835","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0357 Dv Rbc Cp2D As3 450 Lr Irr","code_information":[{"code":"7266837","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0361 Dv Rbc Cp2D As3 450 Lr","code_information":[{"code":"7266838","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0372 Dv Rbc Cp2D As3 500 Lr Irr Open","code_information":[{"code":"7266842","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0375 Dv Rbc Cp2D As3 500 Lr Open","code_information":[{"code":"7266843","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0379 Dv Rbc Cp2D As3 500 Lr Irr","code_information":[{"code":"7266844","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0382 Dv Rbc Cp2D As3 500 Lr","code_information":[{"code":"7266845","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0391 Dv Rbc Cpd As5 450 Lr Irr Open","code_information":[{"code":"7266849","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0394 Dv Rbc Cpd As5 450 Lr Open","code_information":[{"code":"7266850","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0398 Dv Rbc Cpd As5 450 Lr Irr","code_information":[{"code":"7266852","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0401 Dv Rbc Cpd As5 450 Lr","code_information":[{"code":"7266853","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3103 Aph Plt Acda 2","code_information":[{"code":"7266855","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3104 Aph Plt Acda 3","code_information":[{"code":"7266856","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3108 Aph Plt Acdb","code_information":[{"code":"7266857","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3213 Aph Plt Acdb Irr","code_information":[{"code":"7266858","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3214 Aph Plt Acdb Lr Irr","code_information":[{"code":"7266859","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3215 Aph Plt Acdb Lr Irr Plasred","code_information":[{"code":"7266860","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3217 Aph Plt Acdb Lr Irr Plasred 1","code_information":[{"code":"7266861","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3218 Aph Plt Acdb Lr Irr Plasred 2","code_information":[{"code":"7266862","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3219 Aph Plt Acdb Lr Irr Plasred 3","code_information":[{"code":"7266863","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3224 Aph Plt Acdb Lr Irr 1","code_information":[{"code":"7266864","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3225 Aph Plt Acdb Lr Irr 2","code_information":[{"code":"7266865","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3226 Aph Plt Acdb Lr Irr 3","code_information":[{"code":"7266866","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3230 Aph Plt Acdb Irr Plas Red","code_information":[{"code":"7266867","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3232 Aph Plt Acdb Irr Plas Red 1","code_information":[{"code":"7266868","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3233 Aph Plt Acdb Irr Plas Red 2","code_information":[{"code":"7266869","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3234 Aph Plt Acdb Irr Plas Red 3","code_information":[{"code":"7266870","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3239 Aph Plt Acdb Irr 1","code_information":[{"code":"7266871","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3240 Aph Plt Acdb Irr 2","code_information":[{"code":"7266872","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3241 Aph Plt Acdb Irr 3","code_information":[{"code":"7266873","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3245 Aph Plt Acdb Lr","code_information":[{"code":"7266874","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3246 Aph Plt Acdb Lr Plasred","code_information":[{"code":"7266875","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3248 Aph Plt Acdb Lr Plasred 1","code_information":[{"code":"7266876","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3249 Aph Plt Acdb Lr Plasred 2","code_information":[{"code":"7266877","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3250 Aph Plt Acdb Lr Plasred 3","code_information":[{"code":"7266878","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3255 Aph Plt Acdb Lr 1","code_information":[{"code":"7266879","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3256 Aph Plt Acdb Lr 2","code_information":[{"code":"7266880","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3257 Aph Plt Acdb Lr 3","code_information":[{"code":"7266881","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3261 Aph Plt Acdb Plasred","code_information":[{"code":"7266882","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3263 Aph Plt Acdb Plasred 1","code_information":[{"code":"7266883","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3264 Aph Plt Acdb Plasred 2","code_information":[{"code":"7266884","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3265 Aph Plt Acdb Plasred 3","code_information":[{"code":"7266885","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3270 Aph Plt Acdb 1","code_information":[{"code":"7266886","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3271 Aph Plt Acdb 2","code_information":[{"code":"7266887","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3539 Aph Plt Washed","code_information":[{"code":"7266888","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3540 Aph Plt Washed Irr","code_information":[{"code":"7266889","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3541 Aph Plt Washed Lr Irr","code_information":[{"code":"7266890","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3543 Aph Plt Washed Lr Irr 1","code_information":[{"code":"7266891","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3544 Aph Plt Washed Lr Irr 2","code_information":[{"code":"7266892","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3545 Aph Plt Washed Lr Irr 3","code_information":[{"code":"7266893","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3550 Aph Plt Washed Irr 1","code_information":[{"code":"7266894","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3551 Aph Plt Washed Irr 2","code_information":[{"code":"7266895","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3552 Aph Plt Washed Irr 3","code_information":[{"code":"7266896","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3556 Aph Plt Washed Lr","code_information":[{"code":"7266897","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3558 Aph Plt Washed Lr 1","code_information":[{"code":"7266898","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3559 Aph Plt Washed Lr 2","code_information":[{"code":"7266899","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3560 Aph Plt Washed Lr 3","code_information":[{"code":"7266900","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3565 Aph Plt Washed 1","code_information":[{"code":"7266901","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3566 Aph Plt Washed 2","code_information":[{"code":"7266902","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3567 Aph Plt Washed 3","code_information":[{"code":"7266903","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4635 Aph Plt Acda <3 X Log 11","code_information":[{"code":"7266904","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4636 Aph Plt Acda <3 X Log 11 1","code_information":[{"code":"7266905","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4637 Aph Plt Acda <3 X Log 11 2","code_information":[{"code":"7266906","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4640 Aph Plt Acda Irr <3 X Log 11 1","code_information":[{"code":"7266907","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4639 Aph Plt Acda Irr <3 X Log 11","code_information":[{"code":"7266908","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4643 Aph Plt Acda Lr <3 X Log 11","code_information":[{"code":"7266909","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4644 Aph Plt Acda Lr <3 X Log 11 1","code_information":[{"code":"7266910","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4645 Aph Plt Acda Lr <3 X Log 11 2","code_information":[{"code":"7266911","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4647 Aph Plt Acda Lr Irr <3 X Log 11","code_information":[{"code":"7266912","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4648 Aph Plt Acda Lr Irr <3 X Log 11 1","code_information":[{"code":"7266913","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4649 Aph Plt Acda Lr Irr <3 X Log 11 2","code_information":[{"code":"7266914","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4650 Aph Plt Acda Lr Irr <3 X Log 11 3","code_information":[{"code":"7266915","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7001 Aph Plt Acda Pasc Lr","code_information":[{"code":"7266916","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7002 Aph Plt Acda Pasc Lr 1","code_information":[{"code":"7266917","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7003 Aph Plt Acda Pasc Lr 2","code_information":[{"code":"7266918","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7004 Aph Plt Acda Pasc Lr 3","code_information":[{"code":"7266919","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7005 Aph Plt Acda Pasc Lr Irr","code_information":[{"code":"7266920","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7006 Aph Plt Acda Pasc Lr Irr 1","code_information":[{"code":"7266921","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7007 Aph Plt Acda Pasc Lr Irr 2","code_information":[{"code":"7266922","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7008 Aph Plt Acda Pasc Lr Irr 3","code_information":[{"code":"7266923","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1708.0,"discounted_cash":683.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0162 Drbc Cpd 450 Lr Irr","code_information":[{"code":"7266926","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0164 Drbc Cpd 450 Lr","code_information":[{"code":"7266927","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0179 Drbc Cpd 500 Lr Irr","code_information":[{"code":"7266930","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0181 Drbc Cpd 500 Lr","code_information":[{"code":"7266931","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0207 Drbc Cpda1 450 Lr Irr","code_information":[{"code":"7266934","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0209 Drbc Cpda1 450 Lr","code_information":[{"code":"7266935","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0224 Drbc Cpda1 500 Lr Irr","code_information":[{"code":"7266938","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0226 Drbc Cpda1 500 Lr","code_information":[{"code":"7266939","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0257 Drbc Cp2D 450 Lr Irr","code_information":[{"code":"7266943","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0259 Drbc Cp2D 450 Lr","code_information":[{"code":"7266944","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0273 Drbc Cp2D 500 Irr","code_information":[{"code":"7266946","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0274 Drbc Cp2D 500 Lr Irr","code_information":[{"code":"7266947","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0276 Drbc Cp2D 500 Lr","code_information":[{"code":"7266948","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0307 Drbc Cpd As1 450 Lr Irr","code_information":[{"code":"7266952","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0311 Drbc Cpd As1 450 Lr","code_information":[{"code":"7266953","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0336 Drbc Cpd As1 500 Lr","code_information":[{"code":"7266956","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0357 Drbc Cp2D As3 450 Lr Irr","code_information":[{"code":"7266959","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0361 Drbc Cp2D As3 450 Lr","code_information":[{"code":"7266960","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0379 Drbc Cp2D As3 500 Lr Irr","code_information":[{"code":"7266963","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0382 Drbc Cp2D As3 500 Lr","code_information":[{"code":"7266964","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0398 Drbc Cpd As5 450 Lr Irr","code_information":[{"code":"7266966","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0401 Drbc Cpd As5 450 Lr","code_information":[{"code":"7266967","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0420 Drbc Cpd As5 500 Lr Irr","code_information":[{"code":"7266970","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0424 Drbc Cpd As5 500 Lr","code_information":[{"code":"7266971","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0661 Aph Drbc Cp2D As3 Lr Irr","code_information":[{"code":"7266976","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0668 Aph Drbc Cp2D As3 Lr Irr 1","code_information":[{"code":"7266977","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0669 Aph Drbc Cp2D As3 Lr Irr 2","code_information":[{"code":"7266978","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0678 Aph Drbc Cp2D As3 Lr","code_information":[{"code":"7266981","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0686 Aph Drbc Cp2D As3 Lr 2","code_information":[{"code":"7266982","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4144 Aph Drbc Washed Lr","code_information":[{"code":"7266987","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4145 Aph Drbc Washed Lr Irr","code_information":[{"code":"7266988","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4527 Aph Drbc Acda As1 Lr Irr 1","code_information":[{"code":"7266991","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4528 Aph Drbc Acda As1 Lr Irr 2","code_information":[{"code":"7266992","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4531 Aph Drbc Acda As1 Lr","code_information":[{"code":"7266993","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4532 Aph Drbc Acda As1 Lr 1","code_information":[{"code":"7266994","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4533 Aph Drbc Acda As1 Lr 2","code_information":[{"code":"7266995","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4538 Aph Drbc Acda As3 Lr Irr","code_information":[{"code":"7267000","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4539 Aph Drbc Acda As3 Lr Irr 1","code_information":[{"code":"7267001","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4540 Aph Drbc Acda As3 Lr Irr 2","code_information":[{"code":"7267002","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4543 Aph Drbc Acda As3 Lr","code_information":[{"code":"7267005","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4544 Aph Drbc Acda As3 Lr 1","code_information":[{"code":"7267006","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4545 Aph Drbc Acda As3 Lr 2","code_information":[{"code":"7267007","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4560 Aph Drbc Washed Lr Irr 1","code_information":[{"code":"7267010","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4561 Aph Drbc Washed Lr Irr 2","code_information":[{"code":"7267011","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4564 Aph Drbc Washed Lr 1","code_information":[{"code":"7267014","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4565 Aph Drbc Washed Lr 2","code_information":[{"code":"7267015","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4582 Aph Drbc Deglyc Lr Irr","code_information":[{"code":"7267020","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4583 Aph Drbc Deglyc Lr Irr 1","code_information":[{"code":"7267021","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4584 Aph Drbc Deglyc Lr Irr 2","code_information":[{"code":"7267022","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4587 Aph Drbc Deglyc Lr","code_information":[{"code":"7267025","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4588 Aph Drbc Deglyc Lr 1","code_information":[{"code":"7267026","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4589 Aph Drbc Deglyc Lr 2","code_information":[{"code":"7267027","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4633 Drbc Deglyc Rej Lr","code_information":[{"code":"7267030","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4634 Drbc Deglyc Rej Lr Irr","code_information":[{"code":"7267031","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5114 Aph Drbc Cpda1 Lr Irr","code_information":[{"code":"7267034","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5115 Aph Drbc Cpda1 Lr Irr 1","code_information":[{"code":"7267035","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5116 Aph Drbc Cpda1 Lr Irr 2","code_information":[{"code":"7267036","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5117 Aph Drbc Cpda1 Lr","code_information":[{"code":"7267037","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5118 Aph Drbc Cpda1 Lr 1","code_information":[{"code":"7267038","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5119 Aph Drbc Cpda1 Lr 2","code_information":[{"code":"7267039","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5155 Drbc Cpda1 Lr Lv","code_information":[{"code":"7267040","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5156 Drbc Cpda1 Lr Lv Acadj","code_information":[{"code":"7267041","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5169 Drbc Washed Lr","code_information":[{"code":"7267044","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5170 Drbc Washed Lr Irr","code_information":[{"code":"7267045","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5555 Drbc Cpda1 Lr Irr Lv Acadj","code_information":[{"code":"7267048","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6653 Aph Drbc Deglyc As3 Lr 1","code_information":[{"code":"7267049","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6654 Aph Drbc Deglyc As3 Lr 2","code_information":[{"code":"7267050","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6655 Aph Drbc Deglyc As3 Lr Irr 1","code_information":[{"code":"7267051","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6656 Aph Drbc Deglyc As3 Lr Irr 2","code_information":[{"code":"7267052","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4272 Aph Drbc Cp2D Lr Irr","code_information":[{"code":"7267055","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4279 Aph Drbc Cp2D Lr Irr 1","code_information":[{"code":"7267056","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4280 Aph Drbc Cp2D Lr Irr 2","code_information":[{"code":"7267057","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4289 Aph Drbc Cp2D Lr","code_information":[{"code":"7267058","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4296 Aph Drbc Cp2D Lr 1","code_information":[{"code":"7267059","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4297 Aph Drbc Cp2D Lr 2","code_information":[{"code":"7267060","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4362 Aph Drbc Acda Lr Irr","code_information":[{"code":"7267061","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4369 Aph Drbc Acda Lr Irr 1","code_information":[{"code":"7267062","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4370 Aph Drbc Acda Lr Irr 2","code_information":[{"code":"7267063","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4379 Aph Drbc Acda Lr","code_information":[{"code":"7267064","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4386 Aph Drbc Acda Lr 1","code_information":[{"code":"7267065","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4387 Aph Drbc Acda Lr 2","code_information":[{"code":"7267066","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4519 Drbc Deglyc Lr","code_information":[{"code":"7267067","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4521 Drbc Deglyc Lr Irr","code_information":[{"code":"7267069","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4526 Aph Drbc Acda As1 Lr Irr","code_information":[{"code":"7267072","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0332 Drbc Cpd As1 500 Lr Irr","code_information":[{"code":"7267073","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0685 Aph Drbc Cp2D As3 Lr 1","code_information":[{"code":"7267076","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0162 Arbc Cpd 450 Lr Irr","code_information":[{"code":"7267079","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0164 Arbc Cpd 450 Lr","code_information":[{"code":"7267080","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0179 Arbc Cpd 500 Lr Irr","code_information":[{"code":"7267083","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0181 Arbc Cpd 500 Lr","code_information":[{"code":"7267084","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0207 Arbc Cpda1 450 Lr Irr","code_information":[{"code":"7267087","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0209 Arbc Cpda1 450 Lr","code_information":[{"code":"7267088","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0224 Arbc Cpda1 500 Lr Irr","code_information":[{"code":"7267091","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0226 Arbc Cpda1 500 Lr","code_information":[{"code":"7267092","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0257 Arbc Cp2D 450 Lr Irr","code_information":[{"code":"7267096","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0259 Arbc Cp2D 450 Lr","code_information":[{"code":"7267097","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0273 Arbc Cp2D 500 Irr","code_information":[{"code":"7267099","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0274 Arbc Cp2D 500 Lr Irr","code_information":[{"code":"7267100","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0276 Arbc Cp2D 500 Lr","code_information":[{"code":"7267101","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0307 Arbc Cpd As1 450 Lr Irr","code_information":[{"code":"7267105","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0311 Arbc Cpd As1 450 Lr","code_information":[{"code":"7267106","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0332 Arbc Cpd As1 500 Lr Irr","code_information":[{"code":"7267109","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0336 Arbc Cpd As1 500 Lr","code_information":[{"code":"7267110","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0357 Arbc Cp2D As3 450 Lr Irr","code_information":[{"code":"7267113","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0361 Arbc Cp2D As3 450 Lr","code_information":[{"code":"7267114","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0379 Arbc Cp2D As3 500 Lr Irr","code_information":[{"code":"7267117","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0382 Arbc Cp2D As3 500 Lr","code_information":[{"code":"7267118","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0398 Arbc Cpd As5 450 Lr Irr","code_information":[{"code":"7267120","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3581 Thawed Cryo Ahf","code_information":[{"code":"7267123","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3582 Thawed Cryo Ahf Irr","code_information":[{"code":"7267124","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3599 Thawed Aph Cryo","code_information":[{"code":"7267125","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5256 Thawed Cryo","code_information":[{"code":"7267126","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0773 Thawed Ffp Cpd","code_information":[{"code":"7267127","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0782 Thawed Ffp Cpd Irr","code_information":[{"code":"7267128","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0794 Thawed Ffp Cpda1 Irr","code_information":[{"code":"7267130","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0797 Thawed Ffp Cp2D","code_information":[{"code":"7267131","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0806 Thawed Ffp Cp2D Irr","code_information":[{"code":"7267132","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1237 Thawed Aph Ffp Acda","code_information":[{"code":"7267133","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1286 Thawed Aph Ffp Acda Irr","code_information":[{"code":"7267134","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1291 Thawed Aph Ffp Acda Irr <200 Ml","code_information":[{"code":"7267135","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1295 Thawed Aph Ffp Acda Irr 200-400 Ml","code_information":[{"code":"7267136","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1299 Thawed Aph Ffp Acda Irr 400-600 Ml","code_information":[{"code":"7267137","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1301 Thawed Aph Ffp Acda Irr >600 Ml","code_information":[{"code":"7267138","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1310 Thawed Aph Ffp Acda <200 Ml","code_information":[{"code":"7267139","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1314 Thawed Aph Ffp Acda 200-400 Ml","code_information":[{"code":"7267140","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1318 Thawed Aph Ffp Acda 400-600 Ml","code_information":[{"code":"7267141","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1320 Thawed Aph Ffp Acda >600 Ml","code_information":[{"code":"7267142","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1325 Thawed Aph Ffp Nacitrate","code_information":[{"code":"7267143","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E1374 Thawed Aph Ffp Irr Nacitrate","code_information":[{"code":"7267144","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2116 Thawed Aph Plasma Acdb <24H","code_information":[{"code":"7267145","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2225 Thawed Aph Plasma Acda Irr <200 Ml","code_information":[{"code":"7267146","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2243 Thawed Aph Plasma Acda Irr >600 Ml","code_information":[{"code":"7267149","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2260 Thawed Aph Plasma Acda <200 Ml","code_information":[{"code":"7267150","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2266 Thawed Aph Plasma Acda 200-400 Ml","code_information":[{"code":"7267151","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2272 Thawed Aph Plasma Acda 400-600 Ml","code_information":[{"code":"7267152","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2278 Thawed Aph Plasma Acda >600 Ml","code_information":[{"code":"7267153","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2284 Thawed Aph Plasma Acda <24H","code_information":[{"code":"7267154","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2386 Thawed Aph Plasma Irr Nacitrate","code_information":[{"code":"7267155","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2454 Thawed Aph Plasma Nacitrate <24H","code_information":[{"code":"7267156","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2684 Thawed Plasma Cpd","code_information":[{"code":"7267157","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2697 Thawed Plasma Cpd Irr","code_information":[{"code":"7267158","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2699 Thawed Plasma  Cpd Irr <24H","code_information":[{"code":"7267159","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2700 Thawed Plasma Cpd Cryo Red","code_information":[{"code":"7267160","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2701 Thawed Plasma Cpd <24H","code_information":[{"code":"7267161","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2715 Thawed Plasma Cpda1 Irr","code_information":[{"code":"7267163","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2718 Thawed Plasma Cpda1 Cryo Red","code_information":[{"code":"7267164","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2717 Thawed Plasma Cpda1 Irr <24H","code_information":[{"code":"7267165","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2719 Thawed Plasma Cpda1 <24H","code_information":[{"code":"7267166","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2720 Thawed Plasma Cp2D","code_information":[{"code":"7267167","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2733 Thawed Plasma Cp2D Irr","code_information":[{"code":"7267168","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2735 Thawed Plasma Cp2D Irr <24H","code_information":[{"code":"7267169","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2736 Thawed Plasma Cp2D Cryo Red","code_information":[{"code":"7267170","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2737 Thawed Plasma Cp2D <24H","code_information":[{"code":"7267171","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E2754 Thawed Plasma Acdb Cryored","code_information":[{"code":"7267172","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5273 Thawed Aph Ffp Cp2D","code_information":[{"code":"7267176","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9023","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0401 Arbc Cpd As5 450 Lr","code_information":[{"code":"7267177","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0420 Arbc Cpd As5 500 Lr Irr","code_information":[{"code":"7267180","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0424 Arbc Cpd As5 500 Lr","code_information":[{"code":"7267181","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3591 Thawed Pooled Cryo","code_information":[{"code":"7267187","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":398.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3592 Thawed Pooled Cryo Open","code_information":[{"code":"7267188","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":398.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3593 Thawed Pooled Cryo Irr Open","code_information":[{"code":"7267189","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E3594 Thawed Pooled Cryo Irr","code_information":[{"code":"7267190","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0661 Aph Arbc Cp2D As3 Lr Irr","code_information":[{"code":"7267191","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0668 Aph Arbc Cp2D As3 Lr Irr 1","code_information":[{"code":"7267192","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0669 Aph Arbc Cp2D As3 Lr Irr 2","code_information":[{"code":"7267193","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0678 Aph Arbc Cp2D As3 Lr","code_information":[{"code":"7267196","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0685 Aph Arbc Cp2D As3 Lr 1","code_information":[{"code":"7267197","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0686 Aph Arbc Cp2D As3 Lr 2","code_information":[{"code":"7267198","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4144 Aph Arbc Washed Lr","code_information":[{"code":"7267203","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4145 Aph Arbc Washed Lr Irr","code_information":[{"code":"7267204","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4272 Aph Arbc Cp2D Lr Irr","code_information":[{"code":"7267209","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4279 Aph Arbc Cp2D Lr Irr 1","code_information":[{"code":"7267210","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4280 Aph Arbc Cp2D Lr Irr 2","code_information":[{"code":"7267211","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4289 Aph Arbc Cp2D Lr","code_information":[{"code":"7267212","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4296 Aph Arbc Cp2D Lr 1","code_information":[{"code":"7267213","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4297 Aph Arbc Cp2D Lr 2","code_information":[{"code":"7267214","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4362 Aph Arbc Acda Lr Irr","code_information":[{"code":"7267215","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4369 Aph Arbc Acda Lr Irr 1","code_information":[{"code":"7267216","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4370 Aph Arbc Acda Lr Irr 2","code_information":[{"code":"7267217","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4379 Aph Arbc Acda Lr","code_information":[{"code":"7267218","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4387 Aph Arbc Acda Lr 2","code_information":[{"code":"7267219","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4519 Arbc Deglyc Lr","code_information":[{"code":"7267220","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4521 Arbc Deglyc Lr Irr","code_information":[{"code":"7267222","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4526 Aph Arbc Acda As1 Lr Irr","code_information":[{"code":"7267225","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4527 Aph Arbc Acda As1 Lr Irr 1","code_information":[{"code":"7267226","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4531 Aph Arbc Acda As1 Lr","code_information":[{"code":"7267227","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4532 Aph Arbc Acda As1 Lr 1","code_information":[{"code":"7267228","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4533 Aph Arbc Acda As1 Lr 2","code_information":[{"code":"7267229","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4538 Aph Arbc Acda As3 Lr Irr","code_information":[{"code":"7267234","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4540 Aph Arbc Acda As3 Lr Irr 2","code_information":[{"code":"7267235","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4543 Aph Arbc Acda As3 Lr","code_information":[{"code":"7267238","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4544 Aph Arbc Acda As3 Lr 1","code_information":[{"code":"7267239","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4545 Aph Arbc Acda As3 Lr 2","code_information":[{"code":"7267240","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4561 Aph Arbc Washed Lr Irr 2","code_information":[{"code":"7267243","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4564 Aph Arbc Washed Lr 1","code_information":[{"code":"7267246","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4565 Aph Arbc Washed Lr 2","code_information":[{"code":"7267247","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4582 Aph Arbc Deglyc Lr Irr","code_information":[{"code":"7267251","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4583 Aph Arbc Deglyc Lr Irr 1","code_information":[{"code":"7267252","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4584 Aph Arbc Deglyc Lr Irr 2","code_information":[{"code":"7267253","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4587 Aph Arbc Deglyc Lr","code_information":[{"code":"7267256","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4588 Aph Arbc Deglyc Lr 1","code_information":[{"code":"7267257","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4589 Aph Arbc Deglyc Lr 2","code_information":[{"code":"7267258","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4633 Arbc Deglyc Rej Lr","code_information":[{"code":"7267261","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4634 Arbc Deglyc Rej Lr Irr","code_information":[{"code":"7267262","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5114 Aph Arbc Cpda1 Lr Irr","code_information":[{"code":"7267265","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5115 Aph Arbc Cpda1 Lr Irr 1","code_information":[{"code":"7267266","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5116 Aph Arbc Cpda1 Lr Irr 2","code_information":[{"code":"7267267","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5117 Aph Arbc Cpda1 Lr","code_information":[{"code":"7267268","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5118 Aph Arbc Cpda1 Lr 1","code_information":[{"code":"7267269","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5119 Aph Arbc Cpda1 Lr 2","code_information":[{"code":"7267270","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5155 Arbc Cpda1 Lr Lv","code_information":[{"code":"7267271","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5156 Arbc Cpda1 Lr Lv Acadj","code_information":[{"code":"7267272","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5169 Arbc Washed Lr","code_information":[{"code":"7267275","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5170 Arbc Washed Lr Irr","code_information":[{"code":"7267276","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5376 Arbc Cpda1 Lr Irr Lv","code_information":[{"code":"7267279","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5555 Arbc Cpda1 Lr Irr Lv Acadj","code_information":[{"code":"7267280","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6653 Aph Arbc Deglyc As3 Lr 1","code_information":[{"code":"7267281","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6654 Aph Arbc Deglyc As3 Lr 2","code_information":[{"code":"7267282","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6655 Aph Arbc Deglyc As3 Lr Irr 1","code_information":[{"code":"7267283","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6656 Aph Arbc Deglyc As3 Lr Irr 2","code_information":[{"code":"7267284","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5376 Drbc Cpda1 Lr Irr Lv","code_information":[{"code":"7267286","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4386 Aph Arbc Acda Lr 1","code_information":[{"code":"7267289","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4528 Aph Arbc Acda As1 Lr Irr 2","code_information":[{"code":"7267290","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4539 Aph Arbc Acda As3 Lr Irr 1","code_information":[{"code":"7267291","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4560 Aph Arbc Washed Lr Irr 1","code_information":[{"code":"7267292","type":"CDM"},{"code":"390","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0156 Dv Rbc Cpd 450 Lr Irr Open","code_information":[{"code":"7267298","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0158 Dv Rbc Cpd 450 Lr Open","code_information":[{"code":"7267299","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0162 Dv Rbc Cpd 450 Lr Irr","code_information":[{"code":"7267301","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0164 Dv Rbc Cpd 450 Lr","code_information":[{"code":"7267302","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0173 Dv Rbc Cpd 500 Lr Irr Open","code_information":[{"code":"7267306","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0175 Dv Rbc Cpd 500 Lr Open","code_information":[{"code":"7267307","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0179 Dv Rbc Cpd 500 Lr Irr","code_information":[{"code":"7267309","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0181 Dv Rbc Cpd 500 Lr","code_information":[{"code":"7267310","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0626 Aph Dv Rbc Cp2D As3 Lr Irr Open","code_information":[{"code":"7267317","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0633 Aph Dv Rbc Cp2D As3 Lr Irr 1 Open","code_information":[{"code":"7267318","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0634 Aph Dv Rbc Cp2D As3 Lr Irr 2 Open","code_information":[{"code":"7267319","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0643 Aph Dv Rbc Cp2D As3 Lr Open","code_information":[{"code":"7267322","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0650 Aph Dv Rbc Cp2D As3 Lr 1 Open","code_information":[{"code":"7267323","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0651 Aph Dv Rbc Cp2D As3 Lr 2 Open","code_information":[{"code":"7267324","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0661 Aph Dv Rbc Cp2D As3 Lr Irr","code_information":[{"code":"7267328","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0668 Aph Dv Rbc Cp2D As3 Lr Irr 1","code_information":[{"code":"7267329","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0669 Aph Dv Rbc Cp2D As3 Lr Irr 2","code_information":[{"code":"7267330","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0678 Aph Dv Rbc Cp2D As3 Lr","code_information":[{"code":"7267332","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0685 Aph Dv Rbc Cp2D As3 Lr 1","code_information":[{"code":"7267333","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0686 Aph Dv Rbc Cp2D As3 Lr 2","code_information":[{"code":"7267334","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4144 Aph Dv Rbc Washed Lr","code_information":[{"code":"7267339","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4145 Aph Dv Rbc Washed Lr Irr","code_information":[{"code":"7267340","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4237 Aph Dv Rbc Cp2D Lr Irr Open","code_information":[{"code":"7267344","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4244 Aph Dv Rbc Cp2D Lr Irr 1 Open","code_information":[{"code":"7267345","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4245 Aph Dv Rbc Cp2D Lr Irr 2 Open","code_information":[{"code":"7267346","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4254 Aph Dv Rbc Cp2D Lr Open","code_information":[{"code":"7267347","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4261 Aph Dv Rbc Cp2D Lr 1 Open","code_information":[{"code":"7267348","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4262 Aph Dv Rbc Cp2D Lr 2 Open","code_information":[{"code":"7267349","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4272 Aph Dv Rbc Cp2D Lr Irr","code_information":[{"code":"7267350","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4279 Aph Dv Rbc Cp2D Lr Irr 1","code_information":[{"code":"7267351","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4289 Aph Dv Rbc Cp2D Lr","code_information":[{"code":"7267352","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4296 Aph Dv Rbc Cp2D Lr 1","code_information":[{"code":"7267353","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4297 Aph Dv Rbc Cp2D Lr 2","code_information":[{"code":"7267354","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4327 Aph Dv Rbc Acda Lr Irr Open","code_information":[{"code":"7267355","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4334 Aph Dv Rbc Acda Lr Irr 1 Open","code_information":[{"code":"7267356","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4335 Aph Dv Rbc Acda Lr Irr 2 Open","code_information":[{"code":"7267357","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4344 Aph Dv Rbc Acda Lr Open","code_information":[{"code":"7267358","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4351 Aph Dv Rbc Acda Lr 1 Open","code_information":[{"code":"7267359","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4352 Aph Dv Rbc Acda Lr 2 Open","code_information":[{"code":"7267360","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4369 Aph Dv Rbc Acda Lr Irr 1","code_information":[{"code":"7267361","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4370 Aph Dv Rbc Acda Lr Irr 2","code_information":[{"code":"7267362","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4379 Aph Dv Rbc Acda Lr","code_information":[{"code":"7267363","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4386 Aph Dv Rbc Acda Lr 1","code_information":[{"code":"7267364","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4387 Aph Dv Rbc Acda Lr 2","code_information":[{"code":"7267365","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4519 Dv Rbc Deglyc Lr","code_information":[{"code":"7267366","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4521 Dv Rbc Deglyc Lr Irr","code_information":[{"code":"7267368","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4527 Aph Dv Rbc Acda As1 Lr Irr 1","code_information":[{"code":"7267371","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4528 Aph Dv Rbc Acda As1 Lr Irr 2","code_information":[{"code":"7267372","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4531 Aph Dv Rbc Acda As1 Lr","code_information":[{"code":"7267373","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4532 Aph Dv Rbc Acda As1 Lr 1","code_information":[{"code":"7267374","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4533 Aph Dv Rbc Acda As1 Lr 2","code_information":[{"code":"7267375","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4538 Aph Dv Rbc Acda As3 Lr Irr","code_information":[{"code":"7267380","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4540 Aph Dv Rbc Acda As3 Lr Irr 2","code_information":[{"code":"7267381","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0410 Dv Rbc Cpd As5 500 Lr Irr Open","code_information":[{"code":"7267383","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0414 Dv Rbc Cpd As5 500 Lr Open","code_information":[{"code":"7267384","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0420 Dv Rbc Cpd As5 500 Lr Irr","code_information":[{"code":"7267386","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0424 Dv Rbc Cpd As5 500 Lr","code_information":[{"code":"7267387","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4543 Aph Dv Rbc Acda As3 Lr","code_information":[{"code":"7267393","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4544 Aph Dv Rbc Acda As3 Lr 1","code_information":[{"code":"7267394","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4545 Aph Dv Rbc Acda As3 Lr 2","code_information":[{"code":"7267395","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4560 Aph Dv Rbc Washed Lr Irr 1","code_information":[{"code":"7267398","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4561 Aph Dv Rbc Washed Lr Irr 2","code_information":[{"code":"7267399","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4564 Aph Dv Rbc Washed Lr 1","code_information":[{"code":"7267402","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4565 Aph Dv Rbc Washed Lr 2","code_information":[{"code":"7267403","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4582 Aph Dv Rbc Deglyc Lr Irr","code_information":[{"code":"7267408","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4584 Aph Dv Rbc Deglyc Lr Irr 2","code_information":[{"code":"7267409","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4587 Aph Dv Rbc Deglyc Lr","code_information":[{"code":"7267412","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4588 Aph Dv Rbc Deglyc Lr 1","code_information":[{"code":"7267413","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4589 Aph Dv Rbc Deglyc Lr 2","code_information":[{"code":"7267414","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4633 Dv Rbc Deglyc Rej Lr","code_information":[{"code":"7267417","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4634 Dv Rbc Deglyc Rej Lr Irr","code_information":[{"code":"7267418","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5114 Aph Dv Rbc Cpda1 Lr Irr","code_information":[{"code":"7267420","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5115 Aph Dv Rbc Cpda1 Lr Irr 1","code_information":[{"code":"7267421","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5116 Aph Dv Rbc Cpda1 Lr Irr 2","code_information":[{"code":"7267422","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5117 Aph Dv Rbc Cpda1 Lr","code_information":[{"code":"7267423","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5118 Aph Dv Rbc Cpda1 Lr 1","code_information":[{"code":"7267424","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5119 Aph Dv Rbc Cpda1 Lr 2","code_information":[{"code":"7267425","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5155 Dv Rbc Cpda1 Lr Lv","code_information":[{"code":"7267426","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5156 Dv Rbc Cpda1 Lr Lv Acadj","code_information":[{"code":"7267427","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5169 Dv Rbc Washed Lr","code_information":[{"code":"7267429","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5170 Dv Rbc Washed Lr Irr","code_information":[{"code":"7267430","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5376 Dv Rbc Cpda1 Lr Irr Lv","code_information":[{"code":"7267433","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5555 Dv Rbc Cpda1 Lr Irr Lv Acadj","code_information":[{"code":"7267434","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5700 Aph Dv Rbc Acda As3 Lr 1 Open","code_information":[{"code":"7267435","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5704 Aph Dv Rbc Acda As3 Lr Irr Open","code_information":[{"code":"7267436","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5708 Aph Dv Rbc Acda As3 Lr Open","code_information":[{"code":"7267437","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5778 Aph Dv Rbc Acda As1 Lr 1 Open","code_information":[{"code":"7267438","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5783 Aph Dv Rbc Acda As1 Lr Irr 2 Open","code_information":[{"code":"7267440","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5784 Aph Dv Rbc Acda As3 Lr 2 Open","code_information":[{"code":"7267441","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5787 Aph Dv Rbc Acda As1 Lr 2 Open","code_information":[{"code":"7267443","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5793 Aph Dv Rbc Acda As3 Lr Irr 2 Open","code_information":[{"code":"7267448","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5812 Aph Dv Rbc Acda As1 Lr Open","code_information":[{"code":"7267451","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5813 Aph Dv Rbc Cpda1 Lr Open","code_information":[{"code":"7267452","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5814 Aph Dv Rbc Cpda1 Lr 1 Open","code_information":[{"code":"7267453","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5815 Aph Dv Rbc Cpda1 Lr 2 Open","code_information":[{"code":"7267454","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5816 Aph Dv Rbc Acda As1 Lr Irr Open","code_information":[{"code":"7267455","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5818 Aph Dv Rbc Cpda1 Lr Irr Open","code_information":[{"code":"7267456","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5819 Aph Dv Rbc Cpda1 Lr Irr 1 Open","code_information":[{"code":"7267457","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5820 Aph Dv Rbc Cpda1 Lr Irr 2 Open","code_information":[{"code":"7267458","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6653 Aph Dv Rbc Deglyc As3 Lr 1","code_information":[{"code":"7267464","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6654 Aph Dv Rbc Deglyc As3 Lr 2","code_information":[{"code":"7267465","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6655 Aph Dv Rbc Deglyc As3 Lr Irr 1","code_information":[{"code":"7267466","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E6656 Aph Dv Rbc Deglyc As3 Lr Irr 2","code_information":[{"code":"7267467","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7576 Dv Rbc Cpda1 Lr Irr Lv Open","code_information":[{"code":"7267468","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E7577 Dv Rbc Cpda1 Lr Lv Open","code_information":[{"code":"7267469","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4583 Aph Dv Rbc Deglyc Lr Irr 1","code_information":[{"code":"7267472","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5701 Aph Dv Rbc Acda As3 Lr Irr 1 Open","code_information":[{"code":"7267475","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E5817 Aph Dv Rbc Acda As1 Lr Irr 1 Open","code_information":[{"code":"7267477","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E0226 Dv Rbc Cpda1 500 Lr","code_information":[{"code":"7267478","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4280 Aph Dv Rbc Cp2D Lr Irr 2","code_information":[{"code":"7267486","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4362 Aph Dv Rbc Acda Lr Irr","code_information":[{"code":"7267487","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4526 Aph Dv Rbc Acda As1 Lr Irr","code_information":[{"code":"7267488","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"E4539 Aph Dv Rbc Acda As3 Lr Irr 1","code_information":[{"code":"7267489","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hematocrit","code_information":[{"code":"7338543","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"7370228","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.82,"discounted_cash":83.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Slp Eval Of Speech Sound Prod Time","code_information":[{"code":"7370799","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":132.8,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Urine Total Volume Chloride","code_information":[{"code":"7412545","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Total Volume Phosphorus","code_information":[{"code":"7412588","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Psa Free","code_information":[{"code":"7412600","type":"CDM"},{"code":"300","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sodium (U)","code_information":[{"code":"7412763","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Calcium","code_information":[{"code":"7422543","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Local/Sedation","code_information":[{"code":"7454562","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":29.55,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Oxygen Flow Rate","code_information":[{"code":"750674","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":152.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ir Miscellaneous Procedure","code_information":[{"code":"7578730","type":"CDM"},{"code":"333","type":"RC"},{"code":"99999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Temp Btl Caloric","code_information":[{"code":"7626762","type":"CDM"},{"code":"510","type":"RC"},{"code":"92537","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.72,"discounted_cash":138.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":208.04,"discounted_cash":83.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":139.0,"discounted_cash":55.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":346.72,"discounted_cash":138.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Adenoidectomy","code_information":[{"code":"7632577","type":"CDM"},{"code":"361","type":"RC"},{"code":"42830","type":"HCPCS"}],"standard_charges":[{"gross_charge":10121.0,"discounted_cash":4048.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amputation Finger","code_information":[{"code":"7632587","type":"CDM"},{"code":"361","type":"RC"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":8677.0,"discounted_cash":3470.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amputation Toe","code_information":[{"code":"7632594","type":"CDM"},{"code":"361","type":"RC"},{"code":"28820","type":"HCPCS"}],"standard_charges":[{"gross_charge":8930.0,"discounted_cash":3572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anoscopy","code_information":[{"code":"7632601","type":"CDM"},{"code":"750","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":192.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arthroscopy Ankle","code_information":[{"code":"7632681","type":"CDM"},{"code":"29891","type":"HCPCS"}],"standard_charges":[{"gross_charge":8916.0,"discounted_cash":3566.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arthroscopy Knee","code_information":[{"code":"7632684","type":"CDM"},{"code":"360","type":"RC"},{"code":"29884","type":"HCPCS"}],"standard_charges":[{"gross_charge":8677.0,"discounted_cash":3470.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arthroscopy Shoulder","code_information":[{"code":"7632686","type":"CDM"},{"code":"29805","type":"HCPCS"}],"standard_charges":[{"gross_charge":8916.0,"discounted_cash":3566.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arthroscopy Wrist","code_information":[{"code":"7632688","type":"CDM"},{"code":"361","type":"RC"},{"code":"29846","type":"HCPCS"}],"standard_charges":[{"gross_charge":8930.0,"discounted_cash":3572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biopsy Endometrium","code_information":[{"code":"7632735","type":"CDM"},{"code":"761","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biopsy Esophagus","code_information":[{"code":"7632739","type":"CDM"},{"code":"750","type":"RC"},{"code":"43202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.0,"discounted_cash":1101.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bronchoscopy Flexible","code_information":[{"code":"7632840","type":"CDM"},{"code":"750","type":"RC"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3939.0,"discounted_cash":1575.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bronchoscopy With Biopsy","code_information":[{"code":"7632843","type":"CDM"},{"code":"750","type":"RC"},{"code":"31625","type":"HCPCS"}],"standard_charges":[{"gross_charge":3939.0,"discounted_cash":1575.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"7632845","type":"CDM"},{"code":"750","type":"RC"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4796.0,"discounted_cash":1918.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bronchoscopy With Removal Foreign Body","code_information":[{"code":"7632846","type":"CDM"},{"code":"750","type":"RC"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4457.0,"discounted_cash":1782.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bronchoscopy With Ultrasound Ea Add Lobe","code_information":[{"code":"7632849","type":"CDM"},{"code":"750","type":"RC"},{"code":"31633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3800.0,"discounted_cash":1520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ercp","code_information":[{"code":"7632919","type":"CDM"},{"code":"750","type":"RC"},{"code":"43260","type":"HCPCS"}],"standard_charges":[{"gross_charge":7904.0,"discounted_cash":3161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ercp With Biliary Duct Dilatation","code_information":[{"code":"7632920","type":"CDM"},{"code":"750","type":"RC"},{"code":"43277","type":"HCPCS"}],"standard_charges":[{"gross_charge":7904.0,"discounted_cash":3161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ercp With Biopsy","code_information":[{"code":"7632921","type":"CDM"},{"code":"750","type":"RC"},{"code":"43261","type":"HCPCS"}],"standard_charges":[{"gross_charge":7904.0,"discounted_cash":3161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ercp With Mechanical Lithotripsy","code_information":[{"code":"7632925","type":"CDM"},{"code":"750","type":"RC"},{"code":"43265","type":"HCPCS"}],"standard_charges":[{"gross_charge":7904.0,"discounted_cash":3161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ercp With Stent Placement","code_information":[{"code":"7632928","type":"CDM"},{"code":"750","type":"RC"},{"code":"43274","type":"HCPCS"}],"standard_charges":[{"gross_charge":8960.0,"discounted_cash":3584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy","code_information":[{"code":"7632975","type":"CDM"},{"code":"750","type":"RC"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":4028.0,"discounted_cash":1611.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Biopsy","code_information":[{"code":"7632976","type":"CDM"},{"code":"750","type":"RC"},{"code":"45380","type":"HCPCS"}],"standard_charges":[{"gross_charge":3834.0,"discounted_cash":1533.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Biopsy Stoma","code_information":[{"code":"7632977","type":"CDM"},{"code":"750","type":"RC"},{"code":"44389","type":"HCPCS"}],"standard_charges":[{"gross_charge":4028.0,"discounted_cash":1611.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Control Bleeding","code_information":[{"code":"7632978","type":"CDM"},{"code":"750","type":"RC"},{"code":"45382","type":"HCPCS"}],"standard_charges":[{"gross_charge":3834.0,"discounted_cash":1533.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Decompression","code_information":[{"code":"7632980","type":"CDM"},{"code":"750","type":"RC"},{"code":"45378","type":"HCPCS"}],"standard_charges":[{"gross_charge":4028.0,"discounted_cash":1611.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Dilatation","code_information":[{"code":"7632981","type":"CDM"},{"code":"750","type":"RC"},{"code":"45386","type":"HCPCS"}],"standard_charges":[{"gross_charge":4024.0,"discounted_cash":1609.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Excision Lesion/Snare Polpectomy","code_information":[{"code":"7632983","type":"CDM"},{"code":"750","type":"RC"},{"code":"45385","type":"HCPCS"}],"standard_charges":[{"gross_charge":4028.0,"discounted_cash":1611.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Polypectomy Stoma","code_information":[{"code":"7632986","type":"CDM"},{"code":"750","type":"RC"},{"code":"44394","type":"HCPCS"}],"standard_charges":[{"gross_charge":3834.0,"discounted_cash":1533.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colonoscopy Stoma","code_information":[{"code":"7632987","type":"CDM"},{"code":"750","type":"RC"},{"code":"44388","type":"HCPCS"}],"standard_charges":[{"gross_charge":3834.0,"discounted_cash":1533.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Colposcopy","code_information":[{"code":"7633005","type":"CDM"},{"code":"722","type":"RC"},{"code":"57452","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cystoscopy Lithotripsy","code_information":[{"code":"7633093","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":11052.0,"discounted_cash":4420.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cystosocpy Lithotripsy Extracorporeal Shock Wave","code_information":[{"code":"7633095","type":"CDM"},{"code":"790","type":"RC"},{"code":"50590","type":"HCPCS"}],"standard_charges":[{"gross_charge":22422.0,"discounted_cash":8968.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Enteroscopy","code_information":[{"code":"7633285","type":"CDM"},{"code":"750","type":"RC"},{"code":"44360","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Enteroscopy Control Bleeding","code_information":[{"code":"7633287","type":"CDM"},{"code":"750","type":"RC"},{"code":"44366","type":"HCPCS"}],"standard_charges":[{"gross_charge":4917.0,"discounted_cash":1966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Enteroscopy Excision Lesion/Snare Polypectomy","code_information":[{"code":"7633288","type":"CDM"},{"code":"750","type":"RC"},{"code":"44364","type":"HCPCS"}],"standard_charges":[{"gross_charge":4917.0,"discounted_cash":1966.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd","code_information":[{"code":"7633302","type":"CDM"},{"code":"750","type":"RC"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3372.0,"discounted_cash":1348.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd Balloon Dilatation","code_information":[{"code":"7633303","type":"CDM"},{"code":"750","type":"RC"},{"code":"43249","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.0,"discounted_cash":1615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd With Biopsy","code_information":[{"code":"7633304","type":"CDM"},{"code":"750","type":"RC"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":3372.0,"discounted_cash":1348.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd Control Bleeding","code_information":[{"code":"7633305","type":"CDM"},{"code":"750","type":"RC"},{"code":"43255","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.0,"discounted_cash":1615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd Excision Lesion/Snare Polypectomy","code_information":[{"code":"7633307","type":"CDM"},{"code":"750","type":"RC"},{"code":"43251","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.0,"discounted_cash":1615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd Foreign Body Removal","code_information":[{"code":"7633308","type":"CDM"},{"code":"750","type":"RC"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd Gastric Outlet Dilatation","code_information":[{"code":"7633309","type":"CDM"},{"code":"750","type":"RC"},{"code":"43245","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.0,"discounted_cash":1615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd With Submucosal Injection","code_information":[{"code":"7633312","type":"CDM"},{"code":"750","type":"RC"},{"code":"43236","type":"HCPCS"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd With Peg Placement","code_information":[{"code":"7633314","type":"CDM"},{"code":"750","type":"RC"},{"code":"43246","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.0,"discounted_cash":1615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Egd With Variceal Banding","code_information":[{"code":"7633316","type":"CDM"},{"code":"750","type":"RC"},{"code":"43244","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.0,"discounted_cash":1615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Esophagoscopy","code_information":[{"code":"7633317","type":"CDM"},{"code":"750","type":"RC"},{"code":"43200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2674.0,"discounted_cash":1069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Esophagoscopy Balloon Dilatation","code_information":[{"code":"7633319","type":"CDM"},{"code":"750","type":"RC"},{"code":"43220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.0,"discounted_cash":1615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Excision Ganglion Upper Extremity","code_information":[{"code":"7633476","type":"CDM"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2224.0,"discounted_cash":889.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Excision Lipoma Upper Extremity","code_information":[{"code":"7633534","type":"CDM"},{"code":"361","type":"RC"},{"code":"25073","type":"HCPCS"}],"standard_charges":[{"gross_charge":7265.0,"discounted_cash":2906.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Balloon Pump Intra-Aortic","code_information":[{"code":"7633835","type":"CDM"},{"code":"480","type":"RC"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":6599.0,"discounted_cash":2639.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Chest Tube","code_information":[{"code":"7633840","type":"CDM"},{"code":"750","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2079.0,"discounted_cash":831.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lithotripsy Extracorporeal Shock Wave","code_information":[{"code":"7633993","type":"CDM"},{"code":"790","type":"RC"},{"code":"50590","type":"HCPCS"}],"standard_charges":[{"gross_charge":22422.0,"discounted_cash":8968.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Open Reduction Internal Fixation Ankle","code_information":[{"code":"7634107","type":"CDM"},{"code":"361","type":"RC"},{"code":"27823","type":"HCPCS"}],"standard_charges":[{"gross_charge":22694.0,"discounted_cash":9077.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Open Reduction Internal Fixation Clavicle","code_information":[{"code":"7634109","type":"CDM"},{"code":"361","type":"RC"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":19191.0,"discounted_cash":7676.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Open Reduction Internal Fixation Patella","code_information":[{"code":"7634126","type":"CDM"},{"code":"361","type":"RC"},{"code":"27524","type":"HCPCS"}],"standard_charges":[{"gross_charge":22070.0,"discounted_cash":8828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Open Reduction Internal Fixation Radius And Ulna","code_information":[{"code":"7634129","type":"CDM"},{"code":"361","type":"RC"},{"code":"25575","type":"HCPCS"}],"standard_charges":[{"gross_charge":22070.0,"discounted_cash":8828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Open Reduction Internal Fixation Wrist","code_information":[{"code":"7634135","type":"CDM"},{"code":"361","type":"RC"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":22070.0,"discounted_cash":8828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Release Trigger Finger","code_information":[{"code":"7634306","type":"CDM"},{"code":"361","type":"RC"},{"code":"26055","type":"HCPCS"}],"standard_charges":[{"gross_charge":5436.0,"discounted_cash":2174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Hardware Lower Extremity","code_information":[{"code":"7634326","type":"CDM"},{"code":"361","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":7750.0,"discounted_cash":3100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Achilles Tendon","code_information":[{"code":"7634357","type":"CDM"},{"code":"361","type":"RC"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":22070.0,"discounted_cash":8828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Arthroscopy Anterior Cruciate Ligament","code_information":[{"code":"7634380","type":"CDM"},{"code":"361","type":"RC"},{"code":"29888","type":"HCPCS"}],"standard_charges":[{"gross_charge":19735.0,"discounted_cash":7894.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Hallux Valgus","code_information":[{"code":"7634422","type":"CDM"},{"code":"361","type":"RC"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":8677.0,"discounted_cash":3470.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Hammer Toe","code_information":[{"code":"7634423","type":"CDM"},{"code":"361","type":"RC"},{"code":"28285","type":"HCPCS"}],"standard_charges":[{"gross_charge":8677.0,"discounted_cash":3470.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Tendon Upper Extremity","code_information":[{"code":"7634495","type":"CDM"},{"code":"361","type":"RC"},{"code":"24342","type":"HCPCS"}],"standard_charges":[{"gross_charge":19191.0,"discounted_cash":7676.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rhinoplasty","code_information":[{"code":"7634588","type":"CDM"},{"code":"361","type":"RC"},{"code":"30400","type":"HCPCS"}],"standard_charges":[{"gross_charge":18816.0,"discounted_cash":7526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Septoplasty","code_information":[{"code":"7634604","type":"CDM"},{"code":"361","type":"RC"},{"code":"30520","type":"HCPCS"}],"standard_charges":[{"gross_charge":8801.0,"discounted_cash":3520.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sigmoidoscopy Diagnostic","code_information":[{"code":"7634634","type":"CDM"},{"code":"750","type":"RC"},{"code":"45330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2515.0,"discounted_cash":1006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sigmoidoscopy Endoscopic Ultrasound","code_information":[{"code":"7634636","type":"CDM"},{"code":"750","type":"RC"},{"code":"45341","type":"HCPCS"}],"standard_charges":[{"gross_charge":4092.0,"discounted_cash":1636.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stapedectomy","code_information":[{"code":"7634660","type":"CDM"},{"code":"361","type":"RC"},{"code":"69660","type":"HCPCS"}],"standard_charges":[{"gross_charge":16362.0,"discounted_cash":6544.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tonsillectomy","code_information":[{"code":"7634705","type":"CDM"},{"code":"361","type":"RC"},{"code":"42825","type":"HCPCS"}],"standard_charges":[{"gross_charge":18816.0,"discounted_cash":7526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tympanoplasty","code_information":[{"code":"7634743","type":"CDM"},{"code":"361","type":"RC"},{"code":"69631","type":"HCPCS"}],"standard_charges":[{"gross_charge":18816.0,"discounted_cash":7526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Influenza A & B Antigens","code_information":[{"code":"7642540","type":"CDM"},{"code":"306","type":"RC"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fungal Culture Skin/Hair/Nails","code_information":[{"code":"7642548","type":"CDM"},{"code":"300","type":"RC"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bed Bug Identification","code_information":[{"code":"7642550","type":"CDM"},{"code":"300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Giardia Antigen","code_information":[{"code":"7642552","type":"CDM"},{"code":"306","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Macroscopic Parasite Exam","code_information":[{"code":"7642556","type":"CDM"},{"code":"300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Abscess Culture/Gs","code_information":[{"code":"7642557","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bronchial Brush Culture","code_information":[{"code":"7642558","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bronchial Wash Culture/Gs","code_information":[{"code":"7642559","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mrsa Culture","code_information":[{"code":"7642562","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Zzstrep Screens.","code_information":[{"code":"7642564","type":"CDM"},{"code":"306","type":"RC"},{"code":"87430","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Occult Blood Feces","code_information":[{"code":"7642569","type":"CDM"},{"code":"300","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis B Surface Anti Immunity, Quant-(8475)","code_information":[{"code":"7644542","type":"CDM"},{"code":"300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein,Total &  Electro 24 Hour Urine-(750)","code_information":[{"code":"7644558","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroglobulin Panel-(30278)","code_information":[{"code":"7644559","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin D 1,25 - Dihydroxy Level (16558)","code_information":[{"code":"7644560","type":"CDM"},{"code":"300","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Streptococcus Pneumoniae Antigen, Urine-(16786)","code_information":[{"code":"7644562","type":"CDM"},{"code":"300","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":97.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"5-Hiaa Urine 24 Hour-(523)","code_information":[{"code":"7644563","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"5-Hiaa Urine Random-(1648)","code_information":[{"code":"7644564","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"17-Hydroxycorticost W Creat Urine 24 Hour-(15202)","code_information":[{"code":"7644565","type":"CDM"},{"code":"300","type":"RC"},{"code":"83491","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Acetylcholine Receptor Binding Antibody-(206)","code_information":[{"code":"7644566","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Activated Protein C Resistance-(22)","code_information":[{"code":"7644567","type":"CDM"},{"code":"300","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Actin Smooth Muscle Antibody Igg-(15043)","code_information":[{"code":"7644568","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Actinomyces Culture-(3900)","code_information":[{"code":"7644569","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Eosinophil Urine","code_information":[{"code":"7644571","type":"CDM"},{"code":"300","type":"RC"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"T3 Uptake","code_information":[{"code":"7644572","type":"CDM"},{"code":"300","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortisol Am (7-9)","code_information":[{"code":"7644574","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortisol Pm (3-5)","code_information":[{"code":"7644575","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alcohol Ethyl Legal-(443)","code_information":[{"code":"7644577","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alcohol Isopropyl-(578)","code_information":[{"code":"7644578","type":"CDM"},{"code":"300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aldolase-(227)","code_information":[{"code":"7644579","type":"CDM"},{"code":"300","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aldosterone 24 Hour Urine-(229)","code_information":[{"code":"7644580","type":"CDM"},{"code":"300","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aldosterone Lc/Ms/Ms-(17181)","code_information":[{"code":"7644581","type":"CDM"},{"code":"300","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alkaline Phosphatase Bone Specific-(29498)","code_information":[{"code":"7644582","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alkaline Phosphatase Isoenzymes-(231)","code_information":[{"code":"7644583","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adrenocorticotropic Hormone Non Stimulation-(211)","code_information":[{"code":"7644584","type":"CDM"},{"code":"300","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Almond Ige-(2820)","code_information":[{"code":"7644585","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alpha Fetal Protein Body Fluid-(232)","code_information":[{"code":"7644586","type":"CDM"},{"code":"306","type":"RC"},{"code":"82106","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amikacin Level, Peak-(8584)","code_information":[{"code":"7644588","type":"CDM"},{"code":"300","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amikacin Level, Trough-(8583)","code_information":[{"code":"7644589","type":"CDM"},{"code":"300","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amino Acid Analysis-(767)","code_information":[{"code":"7644590","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Delta Aminolevulinic Acid 24 Hour Urine-(-(219)","code_information":[{"code":"7644592","type":"CDM"},{"code":"300","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amphet","code_information":[{"code":"7644593","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ana Ifa Screen With Reflex Titer & Pattern-(249)","code_information":[{"code":"7644594","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anca Screen With Reflex To Anca Titer-(70171)","code_information":[{"code":"7644595","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anca Vasculitides-(36733)","code_information":[{"code":"7644596","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Androstenedione, Lc/Ms/Ms-(17182)","code_information":[{"code":"7644597","type":"CDM"},{"code":"300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":37.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angiotensin Converting Enzyme (Ace)-(683)","code_information":[{"code":"7644601","type":"CDM"},{"code":"300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glomerular Basement Membrane Antibody Igg-(257)","code_information":[{"code":"7644603","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anti Histone Antibodies-(37056)","code_information":[{"code":"7644604","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arsenic Level Urine-(270)","code_information":[{"code":"7644608","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arsenic Level 24 Hour Urine-(36433)","code_information":[{"code":"7644609","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arsenic, Blood Level-(269)","code_information":[{"code":"7644610","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspergillus Antigen, Eia, Serum-(14950)","code_information":[{"code":"7644611","type":"CDM"},{"code":"300","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":144.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta 2 Microglobulin, Serum-(852)","code_information":[{"code":"7644614","type":"CDM"},{"code":"300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bile Acids Fract/Total Preg-(19546)","code_information":[{"code":"7644616","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C-Peptide-(372)","code_information":[{"code":"7644618","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C1 Esterase, Inhibitor Protein-(298)","code_information":[{"code":"7644619","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannabinoids-(8421)","code_information":[{"code":"7644624","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":143.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiolipin Antibody (Iga)-(4661)","code_information":[{"code":"7644625","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiolipin Antibody (Igg)-(4662)","code_information":[{"code":"7644626","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiolipin Antibody (Igm)-(4663)","code_information":[{"code":"7644627","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hs-Crp-(10124)","code_information":[{"code":"7644628","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Cat Dander E1 Ige-(2601)","code_information":[{"code":"7644629","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bartonella Bc Ab (Igg/Igm)-(34251)","code_information":[{"code":"7644631","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catecholamines Fractionated-Total Plasma-(314)","code_information":[{"code":"7644632","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catecholamines Fractionated 24 Hour Urine-(318)","code_information":[{"code":"7644633","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cyclic Citrullinated Peptide Antibody Igg-(11173)","code_information":[{"code":"7644634","type":"CDM"},{"code":"300","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Celiac Disease Comprehensive Panel-(19955)","code_information":[{"code":"7644636","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Centromere B Antibody-(16088)","code_information":[{"code":"7644638","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chlamydia/Neis Gonorrhea Rna, Tma-(11363)","code_information":[{"code":"7644639","type":"CDM"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cholinesterase Serum W/Dibucaine-(7961)","code_information":[{"code":"7644641","type":"CDM"},{"code":"300","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chromium, Serum-(5248)","code_information":[{"code":"7644642","type":"CDM"},{"code":"300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chromosome Analysis Blood-(14596)","code_information":[{"code":"7644643","type":"CDM"},{"code":"300","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":227.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Club Drug Panel 3 Urine-(20387N)","code_information":[{"code":"7644645","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cmv Antibody Igg-(403)","code_information":[{"code":"7644646","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cmv Convent/Rapid Culture-(2627)","code_information":[{"code":"7644647","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cmv Dna Quant Rt By Pcr-(10600)","code_information":[{"code":"7644648","type":"CDM"},{"code":"300","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":128.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cobalt, Blood Level-(35417)","code_information":[{"code":"7644649","type":"CDM"},{"code":"300","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cold Hemagglutinins-(349)","code_information":[{"code":"7644652","type":"CDM"},{"code":"300","type":"RC"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":126.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Collagen Cross-Linked N-Telo Urine-(36167)","code_information":[{"code":"7644653","type":"CDM"},{"code":"300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Complement Total Ch50-(618)","code_information":[{"code":"7644654","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Copper Level-(363)","code_information":[{"code":"7644655","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortisol Free 24 Hr Ur W Crea Lc/Ms/Ms-(11280)","code_information":[{"code":"7644656","type":"CDM"},{"code":"300","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cryoglobulin (% Cryocrit), Serum-(36562)","code_information":[{"code":"7644659","type":"CDM"},{"code":"300","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Viral Culture Body Fluids/Tissue-(689)","code_information":[{"code":"7644661","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cyclosporin A Trough, Blood Level-(8812)","code_information":[{"code":"7644663","type":"CDM"},{"code":"300","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cystic Fibrosis Screen-(81220)","code_information":[{"code":"7644665","type":"CDM"},{"code":"300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6208.0,"discounted_cash":2483.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dermatophagoides Fariae (D2) Ige-(2722)","code_information":[{"code":"7644667","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dhea Sulfate-(402)","code_information":[{"code":"7644668","type":"CDM"},{"code":"300","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Diazepam & Metabolite Level-(90853)","code_information":[{"code":"7644669","type":"CDM"},{"code":"300","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dnase-B Antibody-(256)","code_information":[{"code":"7644670","type":"CDM"},{"code":"300","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Dog Dander/E5 Ige-(2605)","code_information":[{"code":"7644671","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ds Dna Antibodies-(255)","code_information":[{"code":"7644673","type":"CDM"},{"code":"300","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ebv Capsid Antigen Iga, Ifa-(38015)","code_information":[{"code":"7644676","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ebv Early Antigen D Anti (Igg)-(15447)","code_information":[{"code":"7644677","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Egg White F1 Ige-(2801)","code_information":[{"code":"7644678","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Egg Yolk F-75 Ige-(2856)","code_information":[{"code":"7644679","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hereditary Hemochromatosis, Dna Mutation-(35079)","code_information":[{"code":"7644686","type":"CDM"},{"code":"300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":120.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Heroin Screen, Serum/Plasma-(3154)","code_information":[{"code":"7644687","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Histoplasma Galactomannan Ag Urine-(91212)","code_information":[{"code":"7644689","type":"CDM"},{"code":"300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hgb Elect Eval","code_information":[{"code":"7644690","type":"CDM"},{"code":"300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hiv 1 Genotype-(34949)","code_information":[{"code":"7644691","type":"CDM"},{"code":"300","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hiv-1 Rna Quant Real-Time Pcr-(40085)","code_information":[{"code":"7644693","type":"CDM"},{"code":"300","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":82.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hla B-27 Antigen-(528)","code_information":[{"code":"7644694","type":"CDM"},{"code":"300","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hla B-57:01 Typing-(19774)","code_information":[{"code":"7644695","type":"CDM"},{"code":"300","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"U Hydrocodone","code_information":[{"code":"7644697","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":137.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hydroxyproline, Lc/Ms, Plasma-(37558)","code_information":[{"code":"7644698","type":"CDM"},{"code":"300","type":"RC"},{"code":"83500","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Igf 1, Lc/Ms-(16293)","code_information":[{"code":"7644700","type":"CDM"},{"code":"300","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Igf Binding Protein-1 (Igbp-1)-(36590)","code_information":[{"code":"7644701","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":126.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunoglobulin E-(542)","code_information":[{"code":"7644704","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Igg Subclasses Panel-(7903)","code_information":[{"code":"7644706","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Influenza A&B Rna Body Fluid, Ql/Rt, Pcr-(16086)","code_information":[{"code":"7644708","type":"CDM"},{"code":"300","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":94.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Influenza A&B Antibodies-(7250)","code_information":[{"code":"7644709","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":23.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Influenza B, Antibody Serum-(4440)","code_information":[{"code":"7644710","type":"CDM"},{"code":"300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iron Liver Tissue-(8828)","code_information":[{"code":"7644712","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kappa/Lambda Lt Ch, Free W Ratio & Ref-(15122)","code_information":[{"code":"7644714","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lamotrigine Level-(22060)","code_information":[{"code":"7644715","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead, Random Urine Level-(601)","code_information":[{"code":"7644717","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead, Blood Level-(599)","code_information":[{"code":"7644718","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Leukemia/Lymphoma Evaluation-(35080)","code_information":[{"code":"7644720","type":"CDM"},{"code":"300","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":138.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Levetiracetam (Keppra) Level-(15142)","code_information":[{"code":"7644722","type":"CDM"},{"code":"300","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lipoprotein (A)-34604)","code_information":[{"code":"7644723","type":"CDM"},{"code":"300","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":101.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liver Fibrosis, Fibrotest-Actitest Panel-(92688)","code_information":[{"code":"7644724","type":"CDM"},{"code":"300","type":"RC"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phospholipids-(717)","code_information":[{"code":"7644728","type":"CDM"},{"code":"300","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Porphobilinogen, Quantitative 24 Hour Urine-(726)","code_information":[{"code":"7644732","type":"CDM"},{"code":"300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Porphyrins, Fract Quant 24 Hour Urine-(729)","code_information":[{"code":"7644733","type":"CDM"},{"code":"300","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Primidone Level-(751)","code_information":[{"code":"7644734","type":"CDM"},{"code":"300","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Procainamide Level-(743)","code_information":[{"code":"7644735","type":"CDM"},{"code":"300","type":"RC"},{"code":"80192","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Proinsulin Level-(760)","code_information":[{"code":"7644736","type":"CDM"},{"code":"300","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein C Activity-(1777)","code_information":[{"code":"7644737","type":"CDM"},{"code":"300","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":60.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein S Activity-(1779)","code_information":[{"code":"7644738","type":"CDM"},{"code":"300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Proteinase-3 Antibody-(34151)","code_information":[{"code":"7644739","type":"CDM"},{"code":"300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prothrombin (Factor Ii) 20210G Mutation-(17909)","code_information":[{"code":"7644740","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pth-Related Protein (Pth-Rp)-(34478)","code_information":[{"code":"7644741","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Quinidine Level-(766)","code_information":[{"code":"7644742","type":"CDM"},{"code":"300","type":"RC"},{"code":"80194","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rapamycine, Sirolimus Level-(36712)","code_information":[{"code":"7644743","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Renal Biopsy Referred-(Sent To Arkana)","code_information":[{"code":"7644744","type":"CDM"},{"code":"300","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Renin Activity Lc/Ms/Ms, Plasma-(16846)","code_information":[{"code":"7644745","type":"CDM"},{"code":"300","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reverse T3-(90963)","code_information":[{"code":"7644746","type":"CDM"},{"code":"300","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rheumatoid Factor Quantitative","code_information":[{"code":"7644747","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ribosomal P Antibody-(34283)","code_information":[{"code":"7644748","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rotavirus Antigen Detection Stool-(706)","code_information":[{"code":"7644750","type":"CDM"},{"code":"300","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rubella Immune Status-(802)","code_information":[{"code":"7644752","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sample Sent Shipping Included","code_information":[{"code":"7644754","type":"CDM"},{"code":"999","type":"RC"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meconium 13-Panel Drug Screen (Seperate Ticket)","code_information":[{"code":"7644755","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":214.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Substance Abuse Panel 10-50 W Confirm, Ur-(6633)","code_information":[{"code":"7644756","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Se Region Rast","code_information":[{"code":"7644757","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":248.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Seminal Fructose Quantitative-(29812)","code_information":[{"code":"7644758","type":"CDM"},{"code":"300","type":"RC"},{"code":"82757","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":79.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Shrimp F24 Ige-(2824)","code_information":[{"code":"7644759","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Soy Bean F(14) Ige-(2814)","code_information":[{"code":"7644763","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stone Analysis-(30260)","code_information":[{"code":"7644764","type":"CDM"},{"code":"300","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Striated Muscle Antibody W Ref/ Titer-(266)","code_information":[{"code":"7644767","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suscep Mycobac","code_information":[{"code":"7644768","type":"CDM"},{"code":"300","type":"RC"},{"code":"87190","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Susceptibility Yeast Comphrensive Pnl-(17823)","code_information":[{"code":"7644769","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scleroderma Antibody (Scl-70)-(4942)","code_information":[{"code":"7644770","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tetanus Antitoxoid-(4862)","code_information":[{"code":"7644773","type":"CDM"},{"code":"300","type":"RC"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroid Stimulating Immunoglobulin (Tsi)-(30551)","code_information":[{"code":"7644777","type":"CDM"},{"code":"300","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Topiramate Level-(30965)","code_information":[{"code":"7644781","type":"CDM"},{"code":"300","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Toxoplasma Antibodies Igg, Igm-(8636)","code_information":[{"code":"7644783","type":"CDM"},{"code":"300","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Toxoplasma Igg Antibody-(3679)","code_information":[{"code":"7644784","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vma W/O Creatinine 24 Hour Ur-(934)","code_information":[{"code":"7644785","type":"CDM"},{"code":"300","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":60.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Varicella Zoster Virus Antibody Igm-(8683)","code_information":[{"code":"7644786","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vdrl, Csf-(4128)","code_information":[{"code":"7644788","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lacosamide (Vimpat) Level-(16262)","code_information":[{"code":"7644789","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin A (Retinol) Level-(921)","code_information":[{"code":"7644790","type":"CDM"},{"code":"300","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin B1 (Thiamine) Level Lc/Ms/Ms-(5042)","code_information":[{"code":"7644791","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin C (Ascorbic Acid) Level Lc/Ms/Ms-(929)","code_information":[{"code":"7644792","type":"CDM"},{"code":"300","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Volatiles Level-(7240)","code_information":[{"code":"7644793","type":"CDM"},{"code":"300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Von Willebrand Factor Antigen-(4919)","code_information":[{"code":"7644794","type":"CDM"},{"code":"300","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wheat F4 Ige","code_information":[{"code":"7644798","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin E (Tocopherol) Level-(931)","code_information":[{"code":"7644800","type":"CDM"},{"code":"300","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Antithrombin Iii Activity-(216)","code_information":[{"code":"7668562","type":"CDM"},{"code":"300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":38.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cmv Antibody Igm-(8503)","code_information":[{"code":"7668563","type":"CDM"},{"code":"300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ethosuximide-(214)","code_information":[{"code":"7668564","type":"CDM"},{"code":"300","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Felbamate-(3081)","code_information":[{"code":"7668565","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gabapentin-(3557)","code_information":[{"code":"7668566","type":"CDM"},{"code":"300","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis Be Antibody-(556)","code_information":[{"code":"7668567","type":"CDM"},{"code":"300","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Albumin Level Peritoneal Fluid-(17412)","code_information":[{"code":"7674559","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Albumin Level Pleural Fluid-(17413)","code_information":[{"code":"7674560","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Albumin Level Synovial Fluid-(17646)","code_information":[{"code":"7674561","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allergen, Oak T7 Ige-(2507)","code_information":[{"code":"7674562","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peanut F13 Ige","code_information":[{"code":"7674563","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amylase Level Peritoneal Fluid-(17414)","code_information":[{"code":"7674564","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amylase Level Pleural Fluid-(17415)","code_information":[{"code":"7674565","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bk Virus Dna, Rt Pcr, Plasma - (11274)","code_information":[{"code":"7674567","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C3 Pleural Fluid-(17593)","code_information":[{"code":"7674568","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cell Count W/ Diff Manual Body Fluid","code_information":[{"code":"7674571","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":66.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ebv Dna Quant Rt By Pcr-(10186)","code_information":[{"code":"7674574","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Enterovirus .Rna Qual, Rt-Pcr-(15082)","code_information":[{"code":"7674588","type":"CDM"},{"code":"300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Erythropoietin-(427)","code_information":[{"code":"7674591","type":"CDM"},{"code":"300","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ethylene Glycol-(801)","code_information":[{"code":"7674592","type":"CDM"},{"code":"300","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fecal Fat Qualitative-(3967)","code_information":[{"code":"7674594","type":"CDM"},{"code":"300","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fecal Fat, Total, Quant-(455)","code_information":[{"code":"7674595","type":"CDM"},{"code":"300","type":"RC"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":48.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fructosamine-(8340)","code_information":[{"code":"7674597","type":"CDM"},{"code":"300","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gastrin-(478)","code_information":[{"code":"7674602","type":"CDM"},{"code":"300","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose 6 Phos Dehydrogenase, Quant-(500)","code_information":[{"code":"7674603","type":"CDM"},{"code":"300","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose Level Peritoneal Fluid-(17424)","code_information":[{"code":"7674604","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose Level Synovial Fluid-(4410)","code_information":[{"code":"7674606","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glycomark-(19599)","code_information":[{"code":"7674607","type":"CDM"},{"code":"300","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis C Ab Reflex To Hcv, Qn Rt Pcr-(8472)","code_information":[{"code":"7674609","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":132.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Heparin Induced Platelet Antibody-(414)","code_information":[{"code":"7674611","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Heparin Induced Thrombocytopenia Panel-(14874)","code_information":[{"code":"7674612","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis A Antibody Total-(508)","code_information":[{"code":"7674613","type":"CDM"},{"code":"300","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis Be Antigen-(555)","code_information":[{"code":"7674614","type":"CDM"},{"code":"300","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis Panel, Acute W/Rfx To Confirm-(10306)","code_information":[{"code":"7674616","type":"CDM"},{"code":"300","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":138.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Intraoperative Parathyr Post Add Spec","code_information":[{"code":"7674618","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Intraoperative Parathyr Post Operative","code_information":[{"code":"7674619","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Intraoperative Parathyroid  Baseline","code_information":[{"code":"7674620","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lactic Acid 4 Hour","code_information":[{"code":"7674621","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ld, Peritoneal Fluid-(17588)","code_information":[{"code":"7674622","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ld, Synovial Fluid-(17658)","code_information":[{"code":"7674624","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Legionella Culture-(688)","code_information":[{"code":"7674625","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Legionella Pneumophilia Antigen, Dfa-(34475)","code_information":[{"code":"7674626","type":"CDM"},{"code":"300","type":"RC"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lymphocyte Subset Panel 4-(7924)","code_information":[{"code":"7674633","type":"CDM"},{"code":"300","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lymphocyte Subset Panel 5-(8360)","code_information":[{"code":"7674634","type":"CDM"},{"code":"300","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lysozyme (Muramidase)-(619)","code_information":[{"code":"7674635","type":"CDM"},{"code":"300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Magnesium Level Obsterics","code_information":[{"code":"7674636","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mdma & Metabolite-(11332)","code_information":[{"code":"7674638","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Measles Antibody Igg-(964)","code_information":[{"code":"7674639","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mercury, Blood Level-(636)","code_information":[{"code":"7674640","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mercury, Level Random Urine-(637)","code_information":[{"code":"7674641","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Metanephrines Fractionated 24 Hour Ur-(14962)","code_information":[{"code":"7674642","type":"CDM"},{"code":"300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Metanephrines, Fractionated Free Plasma-(19548)","code_information":[{"code":"7674643","type":"CDM"},{"code":"300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Methadone Gc/Ms, Urine-(8418)","code_information":[{"code":"7674644","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Methylmalonic Acid-(34879)","code_information":[{"code":"7674645","type":"CDM"},{"code":"300","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":86.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microalbumin Level Urine","code_information":[{"code":"7674646","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Modified Hodge Test-(18869)","code_information":[{"code":"7674647","type":"CDM"},{"code":"300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Myelin Basic Protein Csf-(663)","code_information":[{"code":"7674650","type":"CDM"},{"code":"300","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Norovirus Eia Stool-(15544)","code_information":[{"code":"7674654","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nortriptyline Level-(272)","code_information":[{"code":"7674655","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oxcarbazepine Metabolite Level-(36637)","code_information":[{"code":"7674656","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oxycodone Confirmation Gc/Ms Urine-(36664)","code_information":[{"code":"7674657","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oxycodone Screen & Confirmation Urine-(14450)","code_information":[{"code":"7674658","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phencyclidine Level By Gc/Ms-(34007)","code_information":[{"code":"7674660","type":"CDM"},{"code":"300","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":97.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein, Total Pericardial Fluid-(17429)","code_information":[{"code":"7674661","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein, Total Peritoneal Fluid-(17428)","code_information":[{"code":"7674662","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein, Total Synovial Fluid-(4404)","code_information":[{"code":"7674663","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sickle Screen","code_information":[{"code":"7674665","type":"CDM"},{"code":"300","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroid Stimulating Hormone W/Ref/Ft4","code_information":[{"code":"7674666","type":"CDM"},{"code":"300","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Total Iron Binding Capacity","code_information":[{"code":"7674667","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Triglyceride Pleural Fluid-(17592)","code_information":[{"code":"7674668","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mss3","code_information":[{"code":"7674669","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Zinc Level-(945)","code_information":[{"code":"7674673","type":"CDM"},{"code":"300","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Zonisamide Level-(37852)","code_information":[{"code":"7674674","type":"CDM"},{"code":"300","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":59.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bal Culture","code_information":[{"code":"7676560","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Temporary Pacemaker","code_information":[{"code":"7686693","type":"CDM"},{"code":"361","type":"RC"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.0,"discounted_cash":673.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"U Microalbumin","code_information":[{"code":"7686782","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Total Volume Bun","code_information":[{"code":"7686905","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Body Fluid Type","code_information":[{"code":"7687026","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":66.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Chest 1 View Portable","code_information":[{"code":"7687091","type":"CDM"},{"code":"400","type":"RC"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"West Nile Virus  Ab Igg Serum","code_information":[{"code":"7687196","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"West Nile Virus Ab Igm Serum","code_information":[{"code":"7687197","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin K Lvl","code_information":[{"code":"7687204","type":"CDM"},{"code":"300","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vitamin B6 (Pyridoxal) Lvl","code_information":[{"code":"7687213","type":"CDM"},{"code":"300","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"West Nile Virus Ab Igg, Csf","code_information":[{"code":"7687254","type":"CDM"},{"code":"300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"West Nile Virus Ab Igm, Csf","code_information":[{"code":"7687255","type":"CDM"},{"code":"300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Varicella Zoster Virus Dna, Ql Rt Pcr","code_information":[{"code":"7687259","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rmsf Igg Ab","code_information":[{"code":"7687291","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rmsf  Igm Ab","code_information":[{"code":"7687297","type":"CDM"},{"code":"300","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sjogrens Syndrome-A Ab, Qn","code_information":[{"code":"7687328","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sjogrens Syndrome-B Ab, Qn","code_information":[{"code":"7687329","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Smooth Muscle Ab Scr","code_information":[{"code":"7687346","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Testosterone, Total","code_information":[{"code":"7687389","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Testosterone, Free","code_information":[{"code":"7687390","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Factor V Mutation","code_information":[{"code":"7687408","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prothrombin Factor Ii","code_information":[{"code":"7687410","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein C Activity","code_information":[{"code":"7687412","type":"CDM"},{"code":"300","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":60.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protein S Antigen, Free","code_information":[{"code":"7687413","type":"CDM"},{"code":"300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroglobulin Ab","code_information":[{"code":"7687417","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroglobulin","code_information":[{"code":"7687420","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Carcinoembryonic Pancreatic Cyst Fluid-(91930)","code_information":[{"code":"7687431","type":"CDM"},{"code":"300","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tissue Transglutaminase Ab, Iga","code_information":[{"code":"7687434","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glutamic Acid Decarboxylase-65 Anti-(34878)","code_information":[{"code":"7687446","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ld, Csf-(1687)","code_information":[{"code":"7687447","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ld, Pericardial Fluid-(17647)","code_information":[{"code":"7687448","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adenosine Deaminase Pleural Fluid-(17696)","code_information":[{"code":"7687451","type":"CDM"},{"code":"300","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Albumin Level Pericardial Fluid-(17411)","code_information":[{"code":"7687452","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Milk F2 Ige","code_information":[{"code":"7687453","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amino Acid Analysis Lc/Ms Urine-(36183)","code_information":[{"code":"7687455","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amylase Level Pancreatic Cyst  Fluid-(Mayo-60078)","code_information":[{"code":"7687456","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angiotensin Converting Enzyme (Ace) Csf Fluid-(34692)","code_information":[{"code":"7687457","type":"CDM"},{"code":"300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bilirubin, Total,  Body Fluid-(Wildarup1)","code_information":[{"code":"7687458","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Calcium Without Creat Level 24 Hour Ur-(11313)","code_information":[{"code":"7687459","type":"CDM"},{"code":"300","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cholesterol Level Pleural Fluid-(17586)","code_information":[{"code":"7687460","type":"CDM"},{"code":"300","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatinine Peritoneal Fluid-(17422)","code_information":[{"code":"7687461","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ehrlichia Chaffeens Dna, Rt Pcr-(11353)","code_information":[{"code":"7687476","type":"CDM"},{"code":"300","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ehrlichia Chaffeensis Igg/Igm-(34271)","code_information":[{"code":"7687477","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Factor V (Leiden) Mutation Analysis-(17900)","code_information":[{"code":"7687478","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Folate, Rbc-(467)","code_information":[{"code":"7687479","type":"CDM"},{"code":"300","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose Level Pericardial Fluid-(17641)","code_information":[{"code":"7687480","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Growth Hormone (Gh)-(521)","code_information":[{"code":"7687481","type":"CDM"},{"code":"300","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hiv Rapid","code_information":[{"code":"7687486","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0432","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lactic Acid","code_information":[{"code":"7687487","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lipase Level Peritoneal Fluid-(17602)","code_information":[{"code":"7687488","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mycobacteria, Culture W Fluorochrome Sm-(4554)","code_information":[{"code":"7687492","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mycoplasma Pneumoniae Antibody Igg-(659)","code_information":[{"code":"7687495","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mycoplasma Pneumoniae Antibody Igm-(21130)","code_information":[{"code":"7687496","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nicotine & Cotinine (Lc/Ms/Ms) Level-(90642)","code_information":[{"code":"7687498","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nicotine & Cotinine (Lc/Ms/Ms) Level Urine-(90646)","code_information":[{"code":"7687499","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oligoclonal Bands Csf & Serum-(674)","code_information":[{"code":"7687500","type":"CDM"},{"code":"300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pancreatic Elastase-1 Stool-(14693)","code_information":[{"code":"7687502","type":"CDM"},{"code":"300","type":"RC"},{"code":"82656","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Serotonin, Blood  Level-(818)","code_information":[{"code":"7687505","type":"CDM"},{"code":"300","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":88.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Triglyceride Peritoneal Fluid-(17591)","code_information":[{"code":"7687506","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Renal Biopsy Sent To Nephropathology","code_information":[{"code":"7687555","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Toxoplasma Gondii Igg Ab, Qn","code_information":[{"code":"7687567","type":"CDM"},{"code":"300","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rubella Ab Igg, Qn","code_information":[{"code":"7687568","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cytomegalovirus Igg Ab, Qn","code_information":[{"code":"7687569","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aldolase","code_information":[{"code":"7687637","type":"CDM"},{"code":"300","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alpha-1-Fetoprotein (Mass/Volume)","code_information":[{"code":"7687670","type":"CDM"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta-Hcg Serum (Mult Of The Median)","code_information":[{"code":"7687716","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alpha Subunit","code_information":[{"code":"7687839","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Igd","code_information":[{"code":"7687848","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Igf Binding Protein-3 (Igbp-3)","code_information":[{"code":"7687868","type":"CDM"},{"code":"300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Albumin  Csf","code_information":[{"code":"7687881","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Igg Csf","code_information":[{"code":"7687884","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Albumin Serum","code_information":[{"code":"7687886","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Islet Cell Ab Screen","code_information":[{"code":"7687921","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":38.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kappa Light Chains, Free Qn S","code_information":[{"code":"7687924","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lambda Light Chains, Free Qn S","code_information":[{"code":"7687926","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alpha-1-Fetoprotein (Multiple Of The Median)","code_information":[{"code":"7688032","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Estriol Unconjugated (Mult Of The Median)","code_information":[{"code":"7688034","type":"CDM"},{"code":"300","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta-Hcg Serum, Qn","code_information":[{"code":"7688035","type":"CDM"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta-Hcg Serum (Mult Of The Median)","code_information":[{"code":"7688036","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inhibin A (Multiple Of The Median)","code_information":[{"code":"7688038","type":"CDM"},{"code":"300","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dermatophagpoides (D1) Ige","code_information":[{"code":"7688166","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dermatophagoides Farinaes (D2) Ige","code_information":[{"code":"7688168","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Penicillum Notatum (M1) Ige","code_information":[{"code":"7688170","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cladosporium Hernarums (M2) Ige","code_information":[{"code":"7688172","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspergillus Fumigatus (M3) Ige","code_information":[{"code":"7688174","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alternaria Alternata (M6) Ige","code_information":[{"code":"7688176","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cat Dander (E1) Ige","code_information":[{"code":"7688179","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dog Dander (E5) Ige","code_information":[{"code":"7688181","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cockroach (16) Ige","code_information":[{"code":"7688183","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Maple (T1) Ige","code_information":[{"code":"7688187","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Birch (T3) Ige","code_information":[{"code":"7688189","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mountain Cedar (T6) Ige","code_information":[{"code":"7688191","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oak (T7) Ige","code_information":[{"code":"7688193","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Elm (T8) Ige","code_information":[{"code":"7688195","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hickory/Pecan Tree (T22) Ige","code_information":[{"code":"7688197","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bermuda Grass (G2) Ige","code_information":[{"code":"7688200","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Timothy Grass (G6) Ige","code_information":[{"code":"7688202","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bahia Grass (G17) Ige","code_information":[{"code":"7688204","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Common Ragweed(Short) (W1) Ige","code_information":[{"code":"7688207","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rough Pigweed (W14) Ige","code_information":[{"code":"7688209","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheep Sorrel (W18) Ige","code_information":[{"code":"7688211","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nettle (W20) Ige","code_information":[{"code":"7688213","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Isolate Id","code_information":[{"code":"7688278","type":"CDM"},{"code":"300","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ana Screen, Ifa","code_information":[{"code":"7688303","type":"CDM"},{"code":"300","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiolipin Ab Igg","code_information":[{"code":"7688366","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiolipin Ab Iga","code_information":[{"code":"7688369","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiolipin Ab Igm","code_information":[{"code":"7688372","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phosphatidylserine Igg Qn (S)","code_information":[{"code":"7688373","type":"CDM"},{"code":"300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Phosphatidylserine Igm Qn (S)","code_information":[{"code":"7688374","type":"CDM"},{"code":"300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta 2 Glycoprotein 1 Igg Qn","code_information":[{"code":"7688376","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta 2 Glycoprotein 1 Igm Qn","code_information":[{"code":"7688377","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta 2 Glycoprotein 1 Iga Qn","code_information":[{"code":"7688378","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"California Igg","code_information":[{"code":"7688395","type":"CDM"},{"code":"300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Eastern Equine Igg","code_information":[{"code":"7688396","type":"CDM"},{"code":"300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"St Louis Igg","code_information":[{"code":"7688397","type":"CDM"},{"code":"300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Western Equine Igg","code_information":[{"code":"7688398","type":"CDM"},{"code":"300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine 24 Arsenic Lvl","code_information":[{"code":"7688405","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"B Henselae Igg Screen","code_information":[{"code":"7688445","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"B Quintana Igg Screen","code_information":[{"code":"7688447","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"B Henselae Igm Screen","code_information":[{"code":"7688449","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"B Quintana Igm Screen","code_information":[{"code":"7688451","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Haptoglobin","code_information":[{"code":"7688699","type":"CDM"},{"code":"300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Apolipoprotein A1","code_information":[{"code":"7688700","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drvvt Screen","code_information":[{"code":"7688795","type":"CDM"},{"code":"300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"B. Burgdorferi Ab, Ia Qn","code_information":[{"code":"7688804","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mitochondrial Ab Scr","code_information":[{"code":"7688912","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Mix (Pt Imm Np Ppp)","code_information":[{"code":"7688924","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Measles Ab Igg, Qn","code_information":[{"code":"7688933","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mumps Ab Igg, Qn","code_information":[{"code":"7688934","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mumps Virus Ab Igm","code_information":[{"code":"7688951","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Acetylcholine Receptor Binding Ab, Qn","code_information":[{"code":"7688960","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Micro Observ Afb Stain","code_information":[{"code":"7688982","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mycobacterium Culture","code_information":[{"code":"7688983","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Myocardial Antibody Screen","code_information":[{"code":"7688999","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ova & Parasites By Trichrome Stain","code_information":[{"code":"7689046","type":"CDM"},{"code":"300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ova & Parasites, Concentration","code_information":[{"code":"7689047","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Parietal Cell Ab Screen","code_information":[{"code":"7689074","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":37.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta 2 Glycoprotein 1 Igg Qn","code_information":[{"code":"7689207","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta 2 Glycoprotein 1 Igm Qn","code_information":[{"code":"7689208","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Beta 2 Glycoprotein 1 Iga Qn","code_information":[{"code":"7689209","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"B. Pertussis Dna","code_information":[{"code":"7689221","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":142.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ca 15-3","code_information":[{"code":"7689232","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Calprotectin Stool","code_information":[{"code":"7689239","type":"CDM"},{"code":"300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":153.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ca 19-9","code_information":[{"code":"7689242","type":"CDM"},{"code":"300","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":48.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Carotene Level","code_information":[{"code":"7689272","type":"CDM"},{"code":"300","type":"RC"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tissue Transglutaminase Ab, Iga","code_information":[{"code":"7689299","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iga","code_information":[{"code":"7689300","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C. Psittaci Ab, Igg","code_information":[{"code":"7689316","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C. Psittaci Ab,Iga","code_information":[{"code":"7689317","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C. Psittaci Ab, Igm","code_information":[{"code":"7689318","type":"CDM"},{"code":"300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chlamydia Trachomatis Dna, Ql","code_information":[{"code":"7689325","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chylomicrons Screen Body Fld","code_information":[{"code":"7689345","type":"CDM"},{"code":"300","type":"RC"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cryofibrinogen","code_information":[{"code":"7689396","type":"CDM"},{"code":"300","type":"RC"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cryptococcus Sp Ag, Ql","code_information":[{"code":"7689417","type":"CDM"},{"code":"300","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dermatophagoides Farinaes (D2) Ige","code_information":[{"code":"7689480","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hsv 1 Igg Type Specific Ab","code_information":[{"code":"7689651","type":"CDM"},{"code":"300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hsv 2 Igg Type Specific Ab","code_information":[{"code":"7689652","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Measles Ab Igg, Qn","code_information":[{"code":"7689654","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endomysial Ab Screen","code_information":[{"code":"7689660","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspergillus Niger Ab, Ql","code_information":[{"code":"7689709","type":"CDM"},{"code":"300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blastomyces Dermatitidis Ab, Ql","code_information":[{"code":"7689714","type":"CDM"},{"code":"300","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Candida Albicans Ab, Ql","code_information":[{"code":"7689717","type":"CDM"},{"code":"300","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coccidioides Immitis Ab, Ql","code_information":[{"code":"7689720","type":"CDM"},{"code":"300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Histoplasma Capsulatum Ab, Ql","code_information":[{"code":"7689723","type":"CDM"},{"code":"300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"1,3 Beta Glucan, Qn","code_information":[{"code":"7689726","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine 24 Arsenic Lvl","code_information":[{"code":"7689772","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine 24 Mercury Lvl","code_information":[{"code":"7689773","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine 24 Lead Lvl","code_information":[{"code":"7689774","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arsenic, Blood","code_information":[{"code":"7689816","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mercury, Blood","code_information":[{"code":"7689817","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead, Blood","code_information":[{"code":"7689818","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Heparin Induced Platelet Ab Ql","code_information":[{"code":"7689849","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"7689970","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.63,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Herpes Simplex Virus 1 Dna, Ql","code_information":[{"code":"7690082","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Herpes Simplex Virus 2 Dna, Ql","code_information":[{"code":"7690083","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hiv Genotype (Susceptibility)","code_information":[{"code":"7690092","type":"CDM"},{"code":"300","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hiv 1/2 Ab + P24 Ag, Ql","code_information":[{"code":"7690106","type":"CDM"},{"code":"300","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hsv 2 Igg Type Specific Ab","code_information":[{"code":"7690119","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Micropolyspora  Faeni","code_information":[{"code":"7690141","type":"CDM"},{"code":"300","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pigeon Serum","code_information":[{"code":"7690142","type":"CDM"},{"code":"300","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Co-Oximeter","code_information":[{"code":"7690203","type":"CDM"},{"code":"300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":95.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cord 1","code_information":[{"code":"7690204","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cord Specimen 2","code_information":[{"code":"7690205","type":"CDM"},{"code":"300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ige","code_information":[{"code":"7690284","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lkm-1 Ab Igg","code_information":[{"code":"7690331","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hs-(Cardio)Crp","code_information":[{"code":"7690347","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cocaine Lvl","code_information":[{"code":"7690360","type":"CDM"},{"code":"300","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thyroid Peroxidase Abs","code_information":[{"code":"7690527","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hsv 2 Igg Type Specific Ab","code_information":[{"code":"7690528","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Uric Acid","code_information":[{"code":"7690572","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"7690615","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.63,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record","code_information":[{"code":"7690623","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.63,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Arsenic/Creatinine (U)","code_information":[{"code":"7690694","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Source Fungal","code_information":[{"code":"7690764","type":"CDM"},{"code":"300","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Smear Fungal","code_information":[{"code":"7690765","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Bun","code_information":[{"code":"7690860","type":"CDM"},{"code":"300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rh","code_information":[{"code":"7690868","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatinine","code_information":[{"code":"7690880","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lidocaine 1%/10 Mg  J2001","code_information":[{"code":"7690937","type":"CDM"},{"code":"J2003","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Miscn1: Nutrition Initial Visit","code_information":[{"code":"7690980","type":"CDM"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Miscn2: Nutrition Follow-Up","code_information":[{"code":"7690981","type":"CDM"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Miscphysical: Physical","code_information":[{"code":"7690982","type":"CDM"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Miscsports: Sports Physical","code_information":[{"code":"7690983","type":"CDM"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Argon Filter","code_information":[{"code":"7691002","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inferior Venocavagram","code_information":[{"code":"7691019","type":"CDM"},{"code":"320","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.0,"discounted_cash":4566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Calcitonin Level-(30742)","code_information":[{"code":"7692773","type":"CDM"},{"code":"300","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspergillus Fumigatus (M3) Ige-(2703)","code_information":[{"code":"7692774","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chlamydia Trachomatis Culture-(690)","code_information":[{"code":"7692778","type":"CDM"},{"code":"300","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cocaine Metabolites, Gc/Ms Urine-(5530)","code_information":[{"code":"7692779","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"A1 Antitrypsin, Qnt-(235)","code_information":[{"code":"7692780","type":"CDM"},{"code":"300","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"17-Hydroxyprogesterone Lc/Ms/Ms","code_information":[{"code":"7692782","type":"CDM"},{"code":"300","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Estrogen Total, Serum-(439)","code_information":[{"code":"7692783","type":"CDM"},{"code":"300","type":"RC"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gamma Hydroxybutyrate Acid Screen Urine-(37653)","code_information":[{"code":"7692784","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gliadin-Deamidated Pep Anti Pnl (Igg/Iga)-(8889)","code_information":[{"code":"7692786","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chrom, Tissue","code_information":[{"code":"7692788","type":"CDM"},{"code":"311","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":295.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Estrone, Lc/Ms/Ms-(23244)","code_information":[{"code":"7692790","type":"CDM"},{"code":"300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Umbilical Cord 13-Panel Drug Screen","code_information":[{"code":"7692792","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oxycodone Pain Mgmt Quant Urine-(16920)","code_information":[{"code":"7692794","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Advantus Ua","code_information":[{"code":"7692802","type":"CDM"},{"code":"300","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sodium (U)","code_information":[{"code":"7692814","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Potassium (U)","code_information":[{"code":"7692815","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chloride (U)","code_information":[{"code":"7692816","type":"CDM"},{"code":"300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"T3 Uptake","code_information":[{"code":"7692822","type":"CDM"},{"code":"300","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fentanyl Screen Ql (U)","code_information":[{"code":"7692877","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ebv Viral Capsid Ag (Vca) Ab (Igm)","code_information":[{"code":"7693032","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ebv Viral Capsid Ag (Vca) Ab  (Igg)","code_information":[{"code":"7693033","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ebv Nuclear Ag (Ebna) Ab( Igg)","code_information":[{"code":"7693034","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anaerobic Id","code_information":[{"code":"7693052","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 3-0","code_information":[{"code":"7694077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Ethilon (Nylon)","code_information":[{"code":"7694079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Sims 2 Cath","code_information":[{"code":"7694083","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio Dy 5Fr Sizing","code_information":[{"code":"7694085","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":97.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio Dy Kb2 Cath","code_information":[{"code":"7694087","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook 6Fr 45 Cm Sheath","code_information":[{"code":"7694089","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook 4Fr Micro Set","code_information":[{"code":"7694091","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Mont 1 Catheter","code_information":[{"code":"7694093","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arrow Rotator Drive","code_information":[{"code":"7694095","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arrow Ptd (Thrombo)","code_information":[{"code":"7694097","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2847.0,"discounted_cash":1138.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tegt 65Cm Cath","code_information":[{"code":"7694099","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Cobra 1 Cath","code_information":[{"code":"7694101","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Homer Mammalok 20G 3Cm","code_information":[{"code":"7694107","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Homer Mammalok 20G 5Cm","code_information":[{"code":"7694109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Homer Mammalok 20G7.5Cm","code_information":[{"code":"7694151","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Homer Mammalok 20G 10Cm","code_information":[{"code":"7694153","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ez Em Entero Kit C970","code_information":[{"code":"7694155","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook 3-Way Stoplock","code_information":[{"code":"7694159","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Niag Cath 5592150","code_information":[{"code":"7694161","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Niagara 5592200","code_information":[{"code":"7694163","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Stiffened 5Fr Micr","code_information":[{"code":"7694165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Wire","code_information":[{"code":"7694167","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Sims 1 Cath","code_information":[{"code":"7694169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Custom Ext","code_information":[{"code":"7694171","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech 14Fr Apd Cath","code_information":[{"code":"7694173","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Rim Cath","code_information":[{"code":"7694175","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis 6Fr Sheath","code_information":[{"code":"7694177","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 4Fr 20Cm","code_information":[{"code":"7694179","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allegiance Angio Pack","code_information":[{"code":"7694181","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tubing, Sterile Art Li","code_information":[{"code":"7694183","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Torque Device","code_information":[{"code":"7694185","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meritmedical Backstop","code_information":[{"code":"7694189","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Lt Catheter 23Cm","code_information":[{"code":"7694192","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1419.0,"discounted_cash":567.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Steerable Cath","code_information":[{"code":"7694194","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Statlock Cath Secure","code_information":[{"code":"7694197","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Crash Cart;  Tube, Flex Guide","code_information":[{"code":"7694199","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit 1-Way Stopcock","code_information":[{"code":"7694201","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Balloon 6X2","code_information":[{"code":"7694203","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Balloon 5X8","code_information":[{"code":"7694205","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Balloon 4X2","code_information":[{"code":"7694207","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Balloon 5X2","code_information":[{"code":"7694209","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microvena Snare Kit","code_information":[{"code":"7694211","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Inflation Device","code_information":[{"code":"7694213","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Flex Cath","code_information":[{"code":"7694215","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allegiance Bx Needle","code_information":[{"code":"7694217","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allegiance Bx Sys 14X9","code_information":[{"code":"7694219","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medrad Sp's Syringe","code_information":[{"code":"7694221","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Injector Tubing","code_information":[{"code":"7694223","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 9Fr 20Cm","code_information":[{"code":"7694225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Bentson Wire","code_information":[{"code":"7694227","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis 9Fr Sheath","code_information":[{"code":"7694229","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fecal Lactoferrin","code_information":[{"code":"7694232","type":"CDM"},{"code":"300","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"H Pylori Antigen-Stool","code_information":[{"code":"7694233","type":"CDM"},{"code":"300","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anes Epidural Blood Patch","code_information":[{"code":"7694240","type":"CDM"},{"code":"370","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":1952.0,"discounted_cash":780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 12Fr 20Cm","code_information":[{"code":"7694242","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Hysterocath","code_information":[{"code":"7694244","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introcan 18G","code_information":[{"code":"7694246","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introcan 20G","code_information":[{"code":"7694248","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introcan 22G","code_information":[{"code":"7694250","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 6Fr 20Cm","code_information":[{"code":"7694252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introcan 20 1 Inch","code_information":[{"code":"7694256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inter-V Core Bx Gun 18X15","code_information":[{"code":"7694261","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Coaxial 17Gax11.8","code_information":[{"code":"7694263","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Amplatz Wire","code_information":[{"code":"7694265","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Kit Abscess","code_information":[{"code":"7694267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Coaxial 17Gax6.8","code_information":[{"code":"7694269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cocaine Confirmation, Gc/Ms  (Bld)-(11328)","code_information":[{"code":"7694286","type":"CDM"},{"code":"300","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Nester 35-14-8","code_information":[{"code":"7694288","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Para Sppt 5F 7","code_information":[{"code":"7694290","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Storq Wire","code_information":[{"code":"7694294","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Stiff Glide","code_information":[{"code":"7694296","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 8Fr 20Cm","code_information":[{"code":"7694298","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard 14X19 Lt Catheter","code_information":[{"code":"7694300","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":493.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Yueh Needle","code_information":[{"code":"7694302","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Airway Laryngeal Mask Sz 5","code_information":[{"code":"7694304","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 10Fr 20Cm","code_information":[{"code":"7694306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 7Fr 20Cm","code_information":[{"code":"7694308","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Sp Probe Cover","code_information":[{"code":"7694310","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pad Electrode, Quadtrode","code_information":[{"code":"7694312","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inter-V Core Bx Gun 18X10","code_information":[{"code":"7694316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Wire .018 60 Cm","code_information":[{"code":"7694318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Wire Ring","code_information":[{"code":"7694320","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":226.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alleg Picc Pack","code_information":[{"code":"7694324","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Abbott 20 Ext Set","code_information":[{"code":"7694326","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech 8 Fr Apd Cath","code_information":[{"code":"7694328","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook 10Fr Pneumo Set","code_information":[{"code":"7694330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":214.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook 5Fr Wsc Sizin Cath","code_information":[{"code":"7694332","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook 4Fr Vert Catheter","code_information":[{"code":"7694334","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scissors, Satin Iris","code_information":[{"code":"7694336","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrodes Adult","code_information":[{"code":"7694338","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baxter Valve Leur","code_information":[{"code":"7694342","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Datascope Safeguard","code_information":[{"code":"7694344","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech 8Fr Neph Cath","code_information":[{"code":"7694346","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arrow Lt Cannon Cath","code_information":[{"code":"7694348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":612.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Medical Cysto Tubing","code_information":[{"code":"7694352","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Coil G06123","code_information":[{"code":"7694354","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Nester 6Mm Coil","code_information":[{"code":"7694356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coil Micro Tornado 35-3-5","code_information":[{"code":"7694358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Coil Mwce 35-4-3","code_information":[{"code":"7694360","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Coil 35-3-5","code_information":[{"code":"7694362","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Statlock Iv Adult","code_information":[{"code":"7694364","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Statlock Iv Peds","code_information":[{"code":"7694366","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Jj Biopatch 7Mm Perm","code_information":[{"code":"7694368","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Jj Biopatch 4Mm Picc","code_information":[{"code":"7694370","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Embolization Coil Mwce 35-10-4","code_information":[{"code":"7694372","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introcan 24G","code_information":[{"code":"7694374","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Oxygen Delivery Module","code_information":[{"code":"7694376","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intubation Module","code_information":[{"code":"7694378","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Iv Delivery Module","code_information":[{"code":"7694380","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intraosseous Module","code_information":[{"code":"7694382","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Oxygen Yellow","code_information":[{"code":"7694384","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intubation Yellow","code_information":[{"code":"7694386","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Grand Slam .014 180Cm","code_information":[{"code":"7694388","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Iv Delivery Yellow","code_information":[{"code":"7694390","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intraosseous Yellow","code_information":[{"code":"7694392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Oxygen Purple","code_information":[{"code":"7694394","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Oxygen Delivery White","code_information":[{"code":"7694396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Oxygen Lt Blue","code_information":[{"code":"7694398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Oxygen Delivery Orange","code_information":[{"code":"7694400","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Oxygen Green","code_information":[{"code":"7694402","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intubation Purple","code_information":[{"code":"7694404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intubation White","code_information":[{"code":"7694406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intubation Lt Blue","code_information":[{"code":"7694408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intubation Orange","code_information":[{"code":"7694410","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intubation Green","code_information":[{"code":"7694412","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Iv Delivery Purple","code_information":[{"code":"7694414","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Iv Delivery White","code_information":[{"code":"7694416","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Iv Delivery Lt Blue","code_information":[{"code":"7694418","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Iv Delivery Orange","code_information":[{"code":"7694420","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Iv Delivery Green","code_information":[{"code":"7694422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intrasosseous Purple","code_information":[{"code":"7694424","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intrasosseous White","code_information":[{"code":"7694426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intrasosseous Lt Blue","code_information":[{"code":"7694428","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intrasosseous Orange","code_information":[{"code":"7694430","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow Intraosseous Green","code_information":[{"code":"7694432","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow 14Fr Nasopharyngeal","code_information":[{"code":"7694434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow 24Fr Nasopharyngeal","code_information":[{"code":"7694436","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe 8G Mammotome St","code_information":[{"code":"7694440","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe 11G Mammotome St","code_information":[{"code":"7694442","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe Guide 8G","code_information":[{"code":"7694444","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mammomark 8G Mam 3008","code_information":[{"code":"7694446","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mallinckro Endo Tube 7","code_information":[{"code":"7694448","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mallinck Endo Tube 7.5","code_information":[{"code":"7694450","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mallinck Endo Tube 8","code_information":[{"code":"7694452","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Crashcart End Tidalc02","code_information":[{"code":"7694454","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Crashcart Peds End C02","code_information":[{"code":"7694456","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Medi-Tech Microcath Kit 18-302","code_information":[{"code":"7694458","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2088.0,"discounted_cash":835.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Infusion Primary Kit","code_information":[{"code":"7694460","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"4X4 Dressing Allevyn","code_information":[{"code":"7694462","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"6.0 Endotrach Tube","code_information":[{"code":"7694464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"6.5 Endotrach Tube","code_information":[{"code":"7694466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech 12Fr 27-138","code_information":[{"code":"7694468","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Datascope Thrombectomy","code_information":[{"code":"7694470","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2273.0,"discounted_cash":909.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Datascope Sm Pressure","code_information":[{"code":"7694472","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amniocentesis Tray","code_information":[{"code":"7694476","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardinal Temno 20X15","code_information":[{"code":"7694478","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardinal Temno 18X20","code_information":[{"code":"7694480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Abbott Starclose 6Fr","code_information":[{"code":"7694482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.0,"discounted_cash":398.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drainage 8X30","code_information":[{"code":"7694484","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drainage 10X30","code_information":[{"code":"7694486","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drainage 12X30","code_information":[{"code":"7694488","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Nester G26993","code_information":[{"code":"7694490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arrow 19 Perm Cath","code_information":[{"code":"7694494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Yeuh 19G 15Cm","code_information":[{"code":"7694496","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Central 3 Lumen","code_information":[{"code":"7694498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard 16G 11Mm Coaxial","code_information":[{"code":"7694502","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard 211610 Needle","code_information":[{"code":"7694504","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard 16G 21Mm Coaxial","code_information":[{"code":"7694506","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filter Line Nasal Cannula","code_information":[{"code":"7694508","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit 19Cm Perm Cath","code_information":[{"code":"7694510","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Terumo Short 6Fr Sheath","code_information":[{"code":"7694512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Syringe 200Ml Ez Em","code_information":[{"code":"7694514","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mammomark Trimark Eviva 2S-13","code_information":[{"code":"7694516","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tru Cut Bx Needle 18X15","code_information":[{"code":"7694518","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook .018 125 Wire","code_information":[{"code":"7694520","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sv Transfer Set","code_information":[{"code":"7694524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tornado 35-5-3","code_information":[{"code":"7694526","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Temno Bx Needle","code_information":[{"code":"7694528","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Nester 35-14-10","code_information":[{"code":"7694530","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Mreye Coil","code_information":[{"code":"7694532","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard 15Cm Trialysis","code_information":[{"code":"7694534","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis 180 Wire","code_information":[{"code":"7694536","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Hilal Coil G07160","code_information":[{"code":"7694538","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tornado G08357","code_information":[{"code":"7694540","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bs Fathom 16 50-910","code_information":[{"code":"7694542","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bs Microcath 18-251","code_information":[{"code":"7694544","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":545.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Mreye Coil G42410","code_information":[{"code":"7694546","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bs Transend 0I8 Wire","code_information":[{"code":"7694548","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit 6Fr Kit","code_information":[{"code":"7694550","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Hilal 18 3.0 3","code_information":[{"code":"7694552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Nester 35-14-12","code_information":[{"code":"7694554","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tornado 35 10/5","code_information":[{"code":"7694556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tornado 18S 7/3","code_information":[{"code":"7694558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tornado 18S 10/4","code_information":[{"code":"7694560","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tornado 35 8/4","code_information":[{"code":"7694562","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Braun Brachial System","code_information":[{"code":"7694566","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Braun Vena Tech Filter","code_information":[{"code":"7694568","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4161.0,"discounted_cash":1664.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Peel Away","code_information":[{"code":"7694570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bs Stent 6/17","code_information":[{"code":"7694572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5076.0,"discounted_cash":2030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tissue Filter","code_information":[{"code":"7694574","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Celero Device","code_information":[{"code":"7694576","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Celero Intr","code_information":[{"code":"7694578","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Securmark","code_information":[{"code":"7694580","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microsphere 500-700","code_information":[{"code":"7694582","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcatheter Embocath","code_information":[{"code":"7694584","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1136.0,"discounted_cash":454.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tenor Guidewire","code_information":[{"code":"7694586","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":293.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Drain Cath 8.5","code_information":[{"code":"7694588","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Drain Cath 10Fr","code_information":[{"code":"7694590","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Drain Cath 12Fr","code_information":[{"code":"7694592","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Yueh Needle G09491","code_information":[{"code":"7694594","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit 5Fr Sheath 11Cm","code_information":[{"code":"7694596","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"7Fr Introducer Sheath","code_information":[{"code":"7694598","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Terumo Glidewire .018","code_information":[{"code":"7694600","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacelabs C02 Line","code_information":[{"code":"7694602","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Trialysis 20Cm","code_information":[{"code":"7694604","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Syringe Mri Kit Medrad","code_information":[{"code":"7694606","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kc Jejunal Feeding Kit","code_information":[{"code":"7694608","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Silverstat Hemostatic","code_information":[{"code":"7694610","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Ret Jug Filter","code_information":[{"code":"7694612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2687.0,"discounted_cash":1074.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Micro Sheath","code_information":[{"code":"7694614","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Trialysis 24Cm","code_information":[{"code":"7694616","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Vcf Femoral","code_information":[{"code":"7694618","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2687.0,"discounted_cash":1074.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Vcf Retrieval","code_information":[{"code":"7694620","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannon Perm 23","code_information":[{"code":"7694628","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bioflow Picc Tray","code_information":[{"code":"7694630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angiodynamics 6Fr Trip","code_information":[{"code":"7694632","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bd Nexiva Diff 24G","code_information":[{"code":"7694634","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bd Nexiva Diffusics 22","code_information":[{"code":"7694636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Vc Filter","code_information":[{"code":"7694640","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3255.0,"discounted_cash":1302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Achieve 16G 11Cm Needle","code_information":[{"code":"7694642","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio 5Fr Introducer","code_information":[{"code":"7694644","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio 6Fr Introducer","code_information":[{"code":"7694646","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio Smart Port","code_information":[{"code":"7694648","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Medical Dilator","code_information":[{"code":"7694650","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Storq 035 300","code_information":[{"code":"7694654","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard 15X42 Perm Cath","code_information":[{"code":"7694656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1132.0,"discounted_cash":452.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liver Bx Needle Set","code_information":[{"code":"7694658","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":507.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lemaitre Otw 3F Cath","code_information":[{"code":"7694660","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lamaitre 0Tw 4F Cath","code_information":[{"code":"7694662","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Short Glide","code_information":[{"code":"7694664","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit 80Cm Amplatz","code_information":[{"code":"7694666","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit 8Fr 11Cm Sheath","code_information":[{"code":"7694668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biosphere 500-700","code_information":[{"code":"7694670","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Ensnare 6Fr","code_information":[{"code":"7694672","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Merit Ensnare 7Fr","code_information":[{"code":"7694674","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":804.0,"discounted_cash":321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bs 27-261 10Fr","code_information":[{"code":"7694676","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angiodyn Berenstein","code_information":[{"code":"7694678","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter 8Fr","code_information":[{"code":"7694680","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Foley Catheter","code_information":[{"code":"7694682","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter 12Fr","code_information":[{"code":"7694684","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter 14Fr","code_information":[{"code":"7694686","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter 16Fr","code_information":[{"code":"7694688","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter 18Fr","code_information":[{"code":"7694690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter 24Fr","code_information":[{"code":"7694692","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter 22Fr","code_information":[{"code":"7694694","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Foley 14Fr","code_information":[{"code":"7694696","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Foley Catheter 22Fr","code_information":[{"code":"7694698","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Catheter Tray","code_information":[{"code":"7694700","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley Cath Tray W/Bag","code_information":[{"code":"7694702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Davis Cath Model Slid","code_information":[{"code":"7694704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ev3 The Big Easy Y-Conn","code_information":[{"code":"7694706","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Drainage Bag","code_information":[{"code":"7694708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coban Wrap","code_information":[{"code":"7694712","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fracture Bedpan","code_information":[{"code":"7694718","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"19G Saf T Butterfly","code_information":[{"code":"7694720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"25G Saf T Butterfly","code_information":[{"code":"7694724","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Iv Jelco 18G","code_information":[{"code":"7694726","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Protective Iv 20G","code_information":[{"code":"7694728","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Jelco 22G","code_information":[{"code":"7694730","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closure Episeal","code_information":[{"code":"7694734","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Steri Strip Closures","code_information":[{"code":"7694736","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Biotac","code_information":[{"code":"7694740","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guaze Vaseline 1X8","code_information":[{"code":"7694742","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"J Vac Bulb Suct Res","code_information":[{"code":"7694756","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"14Fr Suction Cath Kit","code_information":[{"code":"7694758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"23G Saf T Butterfly","code_information":[{"code":"7694768","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Y Type 99 Long Solution","code_information":[{"code":"7694770","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Removal Tray","code_information":[{"code":"7694772","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Vented Secondary","code_information":[{"code":"7694774","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baxter 3 Way Stopcock","code_information":[{"code":"7694780","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urethral Cath Tray","code_information":[{"code":"7694788","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nerve Root Tray","code_information":[{"code":"7694792","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tubing Connecting","code_information":[{"code":"7694796","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"8Fr Infant Feed Tube","code_information":[{"code":"7694798","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ng Tube Salem 18Fr","code_information":[{"code":"7694800","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Canister Suction","code_information":[{"code":"7694804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Central Line Dressing","code_information":[{"code":"7694806","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tegaderm Dressing Tran","code_information":[{"code":"7694808","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tegaderm Dressing 2X2","code_information":[{"code":"7694810","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Transp Bioclu","code_information":[{"code":"7694812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"5Fr Infant Feed Tube","code_information":[{"code":"7694814","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow 30Fr Nasopharyngeal","code_information":[{"code":"7694816","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Primary Pump 110","code_information":[{"code":"7694818","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Jelco 24G","code_information":[{"code":"7694820","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"3.0 Et Tube","code_information":[{"code":"7694822","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 5.5 Cuffed","code_information":[{"code":"7694824","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"3.5 Et Tube","code_information":[{"code":"7694826","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 4.0 Cuffed","code_information":[{"code":"7694828","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 4.5 Cuffed","code_information":[{"code":"7694830","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 6.0 Cuffed","code_information":[{"code":"7694832","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 6.5","code_information":[{"code":"7694834","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow 26Fr Nasopharyngeal","code_information":[{"code":"7694836","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Jackson Pratt 400Ml","code_information":[{"code":"7694840","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Thoracentesis","code_information":[{"code":"7694844","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 5.0 Cuffed","code_information":[{"code":"7694846","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 7.0","code_information":[{"code":"7694848","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endo 7.5","code_information":[{"code":"7694850","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suction Liner","code_information":[{"code":"7694852","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"8Fr Feeding Tube","code_information":[{"code":"7694856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Female Specipan","code_information":[{"code":"7694858","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Single Chest Drain Syst","code_information":[{"code":"7694860","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Jelco 20G","code_information":[{"code":"7694864","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Vented Nitro 106In Long","code_information":[{"code":"7694866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Thoracentesis","code_information":[{"code":"7694868","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bottle Vacuum","code_information":[{"code":"7694870","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Resuscitator Peds","code_information":[{"code":"7694872","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Infuser Pressure In-900012","code_information":[{"code":"7694878","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venigard Jr","code_information":[{"code":"7694882","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow 18Fr Nasopharyngeal","code_information":[{"code":"7694884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow 20Fr Nasopharyngeal","code_information":[{"code":"7694886","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Broselow 22Fr Nasopharyngeal","code_information":[{"code":"7694888","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arrow Twin 20-22G Cath","code_information":[{"code":"7694894","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Arrow 20G","code_information":[{"code":"7694896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suction Tube","code_information":[{"code":"7694898","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Qui Pac","code_information":[{"code":"7694900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":237.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stylet Intubation 14Fr","code_information":[{"code":"7694904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Y Type 112 Long Solution","code_information":[{"code":"7694906","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Pneumothorax","code_information":[{"code":"7694908","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":638.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Resuscitator Infant","code_information":[{"code":"7694910","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Havel Needle 20X6","code_information":[{"code":"7694914","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Male Plug Adapter","code_information":[{"code":"7694918","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bandage Kerlix Roll 4.5X4.1Yd","code_information":[{"code":"7694920","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Huberneedle Gripper","code_information":[{"code":"7694924","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clipper Blade","code_information":[{"code":"7694926","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Kopans Needle","code_information":[{"code":"7694928","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Multipurpose Tray","code_information":[{"code":"7694930","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Needle Dfbn 18-15","code_information":[{"code":"7694932","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dilator 5Fr 20Cm","code_information":[{"code":"7694934","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Ctu 14.0-30-St","code_information":[{"code":"7694936","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Needle Dfbn 20-20","code_information":[{"code":"7694938","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Needle Dchn 18-22","code_information":[{"code":"7694940","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dchn 22-15 Chiba Bx","code_information":[{"code":"7694942","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Needle Dfbn 22-15","code_information":[{"code":"7694944","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Dfbn 22-20","code_information":[{"code":"7694946","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foagrty Catheter 4Fr","code_information":[{"code":"7694948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foagrty Cath 3Fr","code_information":[{"code":"7694950","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bp Cuff Long","code_information":[{"code":"7694958","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Jami","code_information":[{"code":"7694960","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Start Prep Kit","code_information":[{"code":"7694964","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Microtek Bag Decanter","code_information":[{"code":"7694966","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Micro T Set","code_information":[{"code":"7694968","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nasal Cannula","code_information":[{"code":"7694970","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech 10 Neph Ureteral","code_information":[{"code":"7694972","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":160.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scalpel Blade Dsip #11","code_information":[{"code":"7694976","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Smiths 18 Tuohy Epidural","code_information":[{"code":"7694978","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Perc Access Npas","code_information":[{"code":"7694980","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech Apd","code_information":[{"code":"7694984","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Davis Foley 0187 Cath","code_information":[{"code":"7694986","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech 27-135","code_information":[{"code":"7694992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Silicone 16Fr","code_information":[{"code":"7694996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dfib Pad Quick Combo 2 Pak","code_information":[{"code":"7695000","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Macro T Set Ext Tubing","code_information":[{"code":"7695002","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Vansonn 1 Step","code_information":[{"code":"7695004","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"15Fr Feeding","code_information":[{"code":"7695012","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"02 Mask","code_information":[{"code":"7695014","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"02 Tubing","code_information":[{"code":"7695016","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oxisensor Adult","code_information":[{"code":"7695018","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard Ostycutt Bone Bx 16-12.5","code_information":[{"code":"7695033","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bard 14X24 Catheter","code_information":[{"code":"7695035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech Wire","code_information":[{"code":"7695037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Needle Dfbn 18-5.0","code_information":[{"code":"7695039","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Needle Dfbn 22-10","code_information":[{"code":"7695041","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"25G Butterfly","code_information":[{"code":"7695045","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"4492 Butterfly 21X3/4","code_information":[{"code":"7695049","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech Nephrouret St","code_information":[{"code":"7695051","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":245.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook 18G 7Cm Needle","code_information":[{"code":"7695053","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ett Holder","code_information":[{"code":"7695055","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech 260Cm Wire","code_information":[{"code":"7695057","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Tegt 100Cm Cath","code_information":[{"code":"7695059","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Balloon 4X4","code_information":[{"code":"7695061","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":529.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Balloon 5X4","code_information":[{"code":"7695063","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":529.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Meditech Glidewire","code_information":[{"code":"7695065","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gastro Tube","code_information":[{"code":"7695067","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vacuum Cannisters","code_information":[{"code":"7695069","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Wire","code_information":[{"code":"7695073","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hystero Ellip Cath","code_information":[{"code":"7695075","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cook Needle Dfbn 22-5.0","code_information":[{"code":"7695077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis 018 180 Wire","code_information":[{"code":"7695079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Balloon 3X4","code_information":[{"code":"7695081","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2207.0,"discounted_cash":882.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cordis Catheter","code_information":[{"code":"7695083","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tcp99M Cardiolite Up To 40Mci","code_information":[{"code":"7695105","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":261.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tc99M Ceretec Wbc Up To 25 Mci","code_information":[{"code":"7695107","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9521","type":"HCPCS"}],"standard_charges":[{"gross_charge":9510.0,"discounted_cash":3804.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tc99M Cholotec Up To 35Mci","code_information":[{"code":"7695109","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dual Stellant Syringe","code_information":[{"code":"7695113","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tc99M Dtps Aerosol 1-25Mci","code_information":[{"code":"7695115","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9539","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":125.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fdg Per Dose 4-40Mci","code_information":[{"code":"7695117","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1127.0,"discounted_cash":450.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ga-67 Gallium Citrate 1.0Mci","code_information":[{"code":"7695121","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9556","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"I123 Sodium Iodide 100Uci Cap","code_information":[{"code":"7695125","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9516","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"I131 Sodium Iodide Dx Cap","code_information":[{"code":"7695127","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9528","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":331.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"I131 Tx Cap Eaach Addl Mci","code_information":[{"code":"7695129","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9517","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"I131 Tx Cap 1St Mci","code_information":[{"code":"7695131","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9517","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":407.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Indium Per Mci","code_information":[{"code":"7695133","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"discounted_cash":588.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tc99M Maa Up To 10Mci","code_information":[{"code":"7695143","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tcppm Mag 3 Up To 15Mci","code_information":[{"code":"7695145","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"}],"standard_charges":[{"gross_charge":2180.0,"discounted_cash":872.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tcppm Mdp Up To 30Mci","code_information":[{"code":"7695147","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"I131 Mibg 0.5Mci Unit Dose","code_information":[{"code":"7695149","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9508","type":"HCPCS"}],"standard_charges":[{"gross_charge":27626.0,"discounted_cash":11050.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tc99M Myoview Per Study Dose","code_information":[{"code":"7695151","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9502","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bioflo Picc Tray","code_information":[{"code":"7695169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pyrophosphate","code_information":[{"code":"7695171","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9538","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tc99M Sulfur Colloid 1-20Mci","code_information":[{"code":"7695173","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":414.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Ethilon Nylon 664","code_information":[{"code":"7695177","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture 0 Silk Sofsilk 2-0 Silk","code_information":[{"code":"7695179","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thallium 3.5","code_information":[{"code":"7695183","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9505","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":303.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ti-201 Thallous Chlor 1.0Mci","code_information":[{"code":"7695185","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9505","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"3D Render Wo Post Processing","code_information":[{"code":"7695191","type":"CDM"},{"code":"320","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":93.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"3D Render W Post Processing","code_information":[{"code":"7695193","type":"CDM"},{"code":"320","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":238.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C-Arm","code_information":[{"code":"7695195","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inject For Shoulder Arthrogram","code_information":[{"code":"7695199","type":"CDM"},{"code":"360","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inj Si Jnt, Arthgrph-Anes/Strd","code_information":[{"code":"7695201","type":"CDM"},{"code":"360","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1946.0,"discounted_cash":778.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inject Proc,Ankle Arthrography","code_information":[{"code":"7695203","type":"CDM"},{"code":"360","type":"RC"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inject Proc Elbow Arthrography","code_information":[{"code":"7695205","type":"CDM"},{"code":"360","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":259.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inj Px Hip Arthrgphy-W/O Anes","code_information":[{"code":"7695207","type":"CDM"},{"code":"360","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inject Proc, Knee Arthrography","code_information":[{"code":"7695209","type":"CDM"},{"code":"360","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Retro Cystourethrogram Inject.","code_information":[{"code":"7695211","type":"CDM"},{"code":"320","type":"RC"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cysto/Vcug Injection","code_information":[{"code":"7695213","type":"CDM"},{"code":"360","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ndl Plcmnt/Inject Ext Venogram","code_information":[{"code":"7695215","type":"CDM"},{"code":"360","type":"RC"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fluoro Guide Needle Placement","code_information":[{"code":"7695217","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shoulder Arthrography","code_information":[{"code":"7695219","type":"CDM"},{"code":"320","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1423.0,"discounted_cash":569.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Elbow Arthrography","code_information":[{"code":"7695221","type":"CDM"},{"code":"320","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ankle Arthrography","code_information":[{"code":"7695223","type":"CDM"},{"code":"320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Knee Arthrography","code_information":[{"code":"7695225","type":"CDM"},{"code":"320","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hip Arthrography","code_information":[{"code":"7695227","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.0,"discounted_cash":590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Breast Bx/Ea Add'l Lesion","code_information":[{"code":"7695235","type":"CDM"},{"code":"361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Digital Right Unilat Diagnostic","code_information":[{"code":"7695239","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Digital Left Unilat Screening","code_information":[{"code":"7695241","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Digital Right Unilat Screening","code_information":[{"code":"7695243","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Digital Bilateral Diagnostic","code_information":[{"code":"7695245","type":"CDM"},{"code":"401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":191.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Digital Bilateral Screening","code_information":[{"code":"7695247","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Guide Needle Placement-S/I","code_information":[{"code":"7695249","type":"CDM"},{"code":"320","type":"RC"},{"code":"77021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fetal Anat. Eval, Ea. Add Gest","code_information":[{"code":"7695251","type":"CDM"},{"code":"402","type":"RC"},{"code":"76812","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":331.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ob Us Greater  Than 14 Wks Add Gest","code_information":[{"code":"7695253","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ob F/U; Re-Eval., Mult Gest.","code_information":[{"code":"7695255","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Breast Bx, Addl Lesion","code_information":[{"code":"7695257","type":"CDM"},{"code":"361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":218.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ang,Pulm,Nonsl Cth Or Ven Inj","code_information":[{"code":"7695261","type":"CDM"},{"code":"323","type":"RC"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":3221.0,"discounted_cash":1288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Brachial, Retrograde","code_information":[{"code":"7695263","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Carotid,Cerebral,Bilat","code_information":[{"code":"7695265","type":"CDM"},{"code":"323","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":31874.0,"discounted_cash":12749.6,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Angio, Carotid,Cerebral,Unilat","code_information":[{"code":"7695267","type":"CDM"},{"code":"323","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":15937.0,"discounted_cash":6374.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Carotid,Cervical,Bilat","code_information":[{"code":"7695269","type":"CDM"},{"code":"323","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":23182.0,"discounted_cash":9272.8,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Angio, Carotid,Cervical,Unilat","code_information":[{"code":"7695271","type":"CDM"},{"code":"323","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":11591.0,"discounted_cash":4636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Ext Carotid, Bilat, Sel","code_information":[{"code":"7695273","type":"CDM"},{"code":"323","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":5090.0,"discounted_cash":2036.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Angio, Ext Carotid, Unilat,Sel","code_information":[{"code":"7695275","type":"CDM"},{"code":"323","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":2545.0,"discounted_cash":1018.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Extremity, Unilateral","code_information":[{"code":"7695277","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Extremity, Bilateral","code_information":[{"code":"7695279","type":"CDM"},{"code":"323","type":"RC"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.0,"discounted_cash":4566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Pelvic, Sel/Suprasel","code_information":[{"code":"7695281","type":"CDM"},{"code":"323","type":"RC"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Angio, Select, Ea Addl Vessel","code_information":[{"code":"7695283","type":"CDM"},{"code":"323","type":"RC"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":3221.0,"discounted_cash":1288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aortography, Abdominal, Serial","code_information":[{"code":"7695287","type":"CDM"},{"code":"323","type":"RC"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aortography, Thoracic, Serial","code_information":[{"code":"7695289","type":"CDM"},{"code":"323","type":"RC"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dclot Ad Or Cath W/Thrmblytic","code_information":[{"code":"7695291","type":"CDM"},{"code":"320","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilat Nephrstmy/Uretrs/Urethra","code_information":[{"code":"7695293","type":"CDM"},{"code":"320","type":"RC"},{"code":"74485","type":"HCPCS"}],"standard_charges":[{"gross_charge":4479.0,"discounted_cash":1791.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exchg Intrvsclr Cath Dur Thrmb","code_information":[{"code":"7695295","type":"CDM"},{"code":"320","type":"RC"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":9437.0,"discounted_cash":3774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fl-Guide Vad Place,Repl,Remov","code_information":[{"code":"7695299","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fluoro Guidance, Needle Plcmnt","code_information":[{"code":"7695301","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inject Proc, Wrist Arthrogram","code_information":[{"code":"7695303","type":"CDM"},{"code":"360","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insert Bile Duct Drainage Tube","code_information":[{"code":"7695305","type":"CDM"},{"code":"320","type":"RC"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":16015.0,"discounted_cash":6406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insert Indwlng Tnled Plrl Cath","code_information":[{"code":"7695307","type":"CDM"},{"code":"360","type":"RC"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":7950.0,"discounted_cash":3180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insrt Nontunneled Cen Ven Cath","code_information":[{"code":"7695309","type":"CDM"},{"code":"320","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3860.0,"discounted_cash":1544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insrt Tunneled Cen Ven Cath","code_information":[{"code":"7695311","type":"CDM"},{"code":"360","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":8722.0,"discounted_cash":3488.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Intr Ndle/Intr Cath - Ext Art","code_information":[{"code":"7695313","type":"CDM"},{"code":"361","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.0,"discounted_cash":410.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Intro Cath Pulmonary Artery","code_information":[{"code":"7695315","type":"CDM"},{"code":"360","type":"RC"},{"code":"36013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":461.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Intro Of Catheter, Ivc Or Svc","code_information":[{"code":"7695317","type":"CDM"},{"code":"360","type":"RC"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.0,"discounted_cash":790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introduction Of Catheter,Aorta","code_information":[{"code":"7695319","type":"CDM"},{"code":"361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":595.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Intrvsclr Stent Plcmnt;Ea Addl","code_information":[{"code":"7695321","type":"CDM"},{"code":"360","type":"RC"},{"code":"37237","type":"HCPCS"}],"standard_charges":[{"gross_charge":17252.0,"discounted_cash":6900.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mchancl Thrmbctmy W/Fluoro,Art","code_information":[{"code":"7695323","type":"CDM"},{"code":"360","type":"RC"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":13660.0,"discounted_cash":5464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mchancl Thrmbctmy,2Nd&Sub, Art","code_information":[{"code":"7695325","type":"CDM"},{"code":"360","type":"RC"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5567.0,"discounted_cash":2226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mchncl Rmvl Intrlmnl Obs, Cvc","code_information":[{"code":"7695327","type":"CDM"},{"code":"360","type":"RC"},{"code":"36596","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.0,"discounted_cash":1060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mchncl Thrmbctmy, W/Fluoro,Ven","code_information":[{"code":"7695329","type":"CDM"},{"code":"360","type":"RC"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":13660.0,"discounted_cash":5464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mchncl Thrmbctmy,Fluoro,Repeat","code_information":[{"code":"7695331","type":"CDM"},{"code":"360","type":"RC"},{"code":"37188","type":"HCPCS"}],"standard_charges":[{"gross_charge":13660.0,"discounted_cash":5464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ndle/Intrcath,Retro Brach Art","code_information":[{"code":"7695333","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":530.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nephrstgrm,Plstgrm,Lpgrm,Ante","code_information":[{"code":"7695335","type":"CDM"},{"code":"320","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.0,"discounted_cash":513.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Perc Thrmbm Inj;Pseudoaneurysm","code_information":[{"code":"7695341","type":"CDM"},{"code":"360","type":"RC"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":294.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Aorta, Percutaneous","code_information":[{"code":"7695343","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":15625.0,"discounted_cash":6250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Brachcephalic Trnk, Ea Ves","code_information":[{"code":"7695345","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":19840.0,"discounted_cash":7936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Femoral-Popliteal; Percu","code_information":[{"code":"7695347","type":"CDM"},{"code":"360","type":"RC"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":17252.0,"discounted_cash":6900.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Hmdlys Access Av Graft;Art","code_information":[{"code":"7695349","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":19840.0,"discounted_cash":7936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Hmdlys Access Av Graft;Ven","code_information":[{"code":"7695351","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":19840.0,"discounted_cash":7936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Iliac, Percutaneous","code_information":[{"code":"7695353","type":"CDM"},{"code":"320","type":"RC"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":16749.0,"discounted_cash":6699.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Peripheral Artery","code_information":[{"code":"7695355","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Peripheral Artery, Ea Addl","code_information":[{"code":"7695357","type":"CDM"},{"code":"320","type":"RC"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":9437.0,"discounted_cash":3774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pta Tibioperoneal Trnk, Ea Ves","code_information":[{"code":"7695361","type":"CDM"},{"code":"320","type":"RC"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":18072.0,"discounted_cash":7228.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Puncture Shunt Tube For Asp/Inj","code_information":[{"code":"7695363","type":"CDM"},{"code":"360","type":"RC"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":712.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Renal Art Stent Plcmnt W/Pta","code_information":[{"code":"7695365","type":"CDM"},{"code":"320","type":"RC"},{"code":"37236","type":"HCPCS"}],"standard_charges":[{"gross_charge":35672.0,"discounted_cash":14268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Tun/Ntunl Cvc/Picc","code_information":[{"code":"7695367","type":"CDM"},{"code":"320","type":"RC"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.0,"discounted_cash":1060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repostn Of Prev Plcd Cvc W/Flr","code_information":[{"code":"7695369","type":"CDM"},{"code":"360","type":"RC"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.0,"discounted_cash":1060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rmvl Tnld Cvc/Vad Wo Port/Pump","code_information":[{"code":"7695371","type":"CDM"},{"code":"360","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":2292.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rplc Ntnl Cvc, Same Ven Access","code_information":[{"code":"7695373","type":"CDM"},{"code":"320","type":"RC"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.0,"discounted_cash":1060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rplc Picc, Periph Ins,Same Acc","code_information":[{"code":"7695375","type":"CDM"},{"code":"360","type":"RC"},{"code":"36584","type":"HCPCS"}],"standard_charges":[{"gross_charge":2651.0,"discounted_cash":1060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rplc Tnld Cvc, Same Ven Access","code_information":[{"code":"7695377","type":"CDM"},{"code":"360","type":"RC"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":8206.0,"discounted_cash":3282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scndry Mchncl Thrmbctmy,W/Fluo","code_information":[{"code":"7695379","type":"CDM"},{"code":"360","type":"RC"},{"code":"37186","type":"HCPCS"}],"standard_charges":[{"gross_charge":5567.0,"discounted_cash":2226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp 1St Order;Thor/Brachioceph","code_information":[{"code":"7695381","type":"CDM"},{"code":"360","type":"RC"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1588.0,"discounted_cash":635.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp Venous, 1St Order Branch","code_information":[{"code":"7695383","type":"CDM"},{"code":"361","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":461.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp Venous,2Nd Ord/More Branch","code_information":[{"code":"7695385","type":"CDM"},{"code":"360","type":"RC"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.0,"discounted_cash":552.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp, Init 2Nd, Thor/Brchiocphlic","code_information":[{"code":"7695387","type":"CDM"},{"code":"320","type":"RC"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.0,"discounted_cash":819.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp, Init 3Rd, Thor/Brchiocphlic","code_information":[{"code":"7695389","type":"CDM"},{"code":"320","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.0,"discounted_cash":951.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp, Left Or Right Pulm Artery","code_information":[{"code":"7695391","type":"CDM"},{"code":"320","type":"RC"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.0,"discounted_cash":552.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp, Segmntl/Sbsgmntl Pulm Art","code_information":[{"code":"7695393","type":"CDM"},{"code":"360","type":"RC"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":644.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp; Ea 1St Ord;Abd/Pel/Lowext","code_information":[{"code":"7695395","type":"CDM"},{"code":"320","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1655.0,"discounted_cash":662.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scp; Init 3Rd Or;Abd/Pel/Lowext","code_information":[{"code":"7695397","type":"CDM"},{"code":"360","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2315.0,"discounted_cash":926.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Plcmnt, Venous, W/Wo Pta","code_information":[{"code":"7695399","type":"CDM"},{"code":"320","type":"RC"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":35672.0,"discounted_cash":14268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Superior Venocavagram","code_information":[{"code":"7695401","type":"CDM"},{"code":"320","type":"RC"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":3221.0,"discounted_cash":1288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thrombectmy,Percu, Av Fistula","code_information":[{"code":"7695403","type":"CDM"},{"code":"320","type":"RC"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":12594.0,"discounted_cash":5037.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Transcath Embo., F/U Therapy","code_information":[{"code":"7695405","type":"CDM"},{"code":"320","type":"RC"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":657.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Transcath Embo., Initial Perc","code_information":[{"code":"7695407","type":"CDM"},{"code":"320","type":"RC"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":34587.0,"discounted_cash":13834.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trnscth Tx Inf-Oth Thn Thrblys","code_information":[{"code":"7695409","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":6615.0,"discounted_cash":2646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trnscth Tx, Thromblys Infusion","code_information":[{"code":"7695411","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":657.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trnslm Bln Angpls, Ea Addl Art","code_information":[{"code":"7695413","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trnslm Bln Angpls,Renal/Viscrl","code_information":[{"code":"7695415","type":"CDM"},{"code":"320","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trnslmnl Bln Angplsty, Venous","code_information":[{"code":"7695417","type":"CDM"},{"code":"320","type":"RC"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":11135.0,"discounted_cash":4454.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Guide For Vascular Access","code_information":[{"code":"7695419","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.0,"discounted_cash":422.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Guide Needle-Bx/Inj/Asp/Loc","code_information":[{"code":"7695421","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ven Cath,Sel Orgn Bld Sampling","code_information":[{"code":"7695423","type":"CDM"},{"code":"360","type":"RC"},{"code":"36500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1165.0,"discounted_cash":466.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venography, Adrenal, Bilateral","code_information":[{"code":"7695425","type":"CDM"},{"code":"320","type":"RC"},{"code":"75842","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venography, Adrenal, Unilat","code_information":[{"code":"7695427","type":"CDM"},{"code":"320","type":"RC"},{"code":"75840","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venography, Extremity, Unilat","code_information":[{"code":"7695429","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3428.0,"discounted_cash":1371.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venography, Renal, Bilateral","code_information":[{"code":"7695431","type":"CDM"},{"code":"320","type":"RC"},{"code":"75833","type":"HCPCS"}],"standard_charges":[{"gross_charge":10278.0,"discounted_cash":4111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venography, Renal, Unilateral","code_information":[{"code":"7695433","type":"CDM"},{"code":"320","type":"RC"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":10749.0,"discounted_cash":4299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venous Sampling","code_information":[{"code":"7695435","type":"CDM"},{"code":"320","type":"RC"},{"code":"75893","type":"HCPCS"}],"standard_charges":[{"gross_charge":10749.0,"discounted_cash":4299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vgram,Hepatic,W/Hemdynmic Eval","code_information":[{"code":"7695437","type":"CDM"},{"code":"320","type":"RC"},{"code":"75889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vgram,Hepatic,W/O Hmdynmc Eval","code_information":[{"code":"7695439","type":"CDM"},{"code":"320","type":"RC"},{"code":"75891","type":"HCPCS"}],"standard_charges":[{"gross_charge":10749.0,"discounted_cash":4299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"10021 Ap Bill Fna Superficial","code_information":[{"code":"7695999","type":"CDM"},{"code":"761","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88333 Ap Bill Touch Prep","code_information":[{"code":"7696001","type":"CDM"},{"code":"310","type":"RC"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88000 Ap Bill Autopsy, External Only","code_information":[{"code":"7696002","type":"CDM"},{"code":"310","type":"RC"},{"code":"88000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.0,"discounted_cash":478.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88025 Ap Bill Autopsy With Brain, Adult","code_information":[{"code":"7696003","type":"CDM"},{"code":"310","type":"RC"},{"code":"88025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1745.0,"discounted_cash":698.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88374 Ap Bill Her-2 Fish By Phenopath","code_information":[{"code":"7696009","type":"CDM"},{"code":"300","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":368.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88387 Ap Bill Tissue Bank Prep Without Consult","code_information":[{"code":"7696010","type":"CDM"},{"code":"310","type":"RC"},{"code":"88387","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88162 Ap Bill Nongyn Other Extended (5 Plus Slides,Prep,Interpret)","code_information":[{"code":"7696011","type":"CDM"},{"code":"310","type":"RC"},{"code":"88162","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88161 Ap Bill Nongyn Other Limited (Prep,Interpret)","code_information":[{"code":"7696012","type":"CDM"},{"code":"310","type":"RC"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"99195 Ap Bill Therapeutic Phlebotomy","code_information":[{"code":"7696013","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88334 Ap Bill Touch Prep, Additional, Each","code_information":[{"code":"7696014","type":"CDM"},{"code":"310","type":"RC"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"87207 Ap Bill Tzank Smear (Herpes Cytology)","code_information":[{"code":"7696015","type":"CDM"},{"code":"300","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88184 Ap Bill Flow Cytometry 1St Marker","code_information":[{"code":"7696016","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88185 Ap Bill Flow Cytometry, Addtl Marker","code_information":[{"code":"7696017","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":54.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88237 Ap Bill Cytogenetics Tissue Culture","code_information":[{"code":"7696018","type":"CDM"},{"code":"311","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88264 Ap Bill Cytogenetics Analyze 20-25 Cells","code_information":[{"code":"7696019","type":"CDM"},{"code":"311","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88285 Ap Bill Cytogenetics Addtl Cells Counted, Each Study","code_information":[{"code":"7696020","type":"CDM"},{"code":"300","type":"RC"},{"code":"88285","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88280 Ap Bill Cytogenetics, Chromosome Analysis","code_information":[{"code":"7696021","type":"CDM"},{"code":"311","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":81.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88367 Ap Bill Morphometric Analysis (Ish), Initial Single Probe,Comp","code_information":[{"code":"7696022","type":"CDM"},{"code":"311","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":400.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88368 Ap Bill Morphometric Analysis (Ish), Initial Single Probe,Manual","code_information":[{"code":"7696023","type":"CDM"},{"code":"310","type":"RC"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":1929.0,"discounted_cash":771.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88373 Ap Bill Morphometric Analysis (Ish),Ea Addtl Single Probe","code_information":[{"code":"7696024","type":"CDM"},{"code":"300","type":"RC"},{"code":"88373","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88374 Ap Bill Morphometric Analysis (Ish), Ea Multiplex Probe","code_information":[{"code":"7696025","type":"CDM"},{"code":"300","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":368.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88360 Ap Bill Morphometric Analysis, Tumor Ihc","code_information":[{"code":"7696031","type":"CDM"},{"code":"300","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"88177 Ap Bill Immediate Cytohistologic Study For Adequacy","code_information":[{"code":"7696033","type":"CDM"},{"code":"310","type":"RC"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Abo Type","code_information":[{"code":"7697690","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Rh Type","code_information":[{"code":"7697691","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":30.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Phenotyping Complete","code_information":[{"code":"7697692","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Rbc Ag, Other Than Abo Or D, Each","code_information":[{"code":"7697693","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Dat, Each Antisera","code_information":[{"code":"7697694","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":35.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Antibody Screen, Each Media","code_information":[{"code":"7697695","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Ab Id/Each Panel & Media","code_information":[{"code":"7697696","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Ab Id/Each Selected Reagent Cell","code_information":[{"code":"7697697","type":"CDM"},{"code":"300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Pre-Treatment With Enzymes, Per Cell","code_information":[{"code":"7697698","type":"CDM"},{"code":"300","type":"RC"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Differential/Auto Ads Of Serum, Each Ads","code_information":[{"code":"7697699","type":"CDM"},{"code":"300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":98.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Cold Agglutinin Titer","code_information":[{"code":"7697700","type":"CDM"},{"code":"300","type":"RC"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bill Arc Separation By Density Gradient, Retics","code_information":[{"code":"7697701","type":"CDM"},{"code":"300","type":"RC"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Onc Infections Panel","code_information":[{"code":"7697731","type":"CDM"},{"code":"300","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":48.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abd And Pelvis W/ Iv Contrast Only","code_information":[{"code":"7697897","type":"CDM"},{"code":"352","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":6412.0,"discounted_cash":2564.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abd And Pelvis W/ Oral Contrast Only","code_information":[{"code":"7697900","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":4510.0,"discounted_cash":1804.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abdomen W/ Iv Contrast Only","code_information":[{"code":"7697903","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":1282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Abdomen W/ Oral Contrast Only","code_information":[{"code":"7697906","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Lower Extremity","code_information":[{"code":"7697909","type":"CDM"},{"code":"320","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Renal Arteries","code_information":[{"code":"7697912","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":2673.0,"discounted_cash":1069.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Upper Extremity","code_information":[{"code":"7697915","type":"CDM"},{"code":"320","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3077.0,"discounted_cash":1230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Aspiration W/O Contrast","code_information":[{"code":"7697918","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Adrenal Gland Left","code_information":[{"code":"7697921","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Bowel","code_information":[{"code":"7697927","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Salivary/Parotid Gland","code_information":[{"code":"7697930","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Biopsy Thyroid","code_information":[{"code":"7697933","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Brain Attack Ed/Ip Stroke Protocol","code_information":[{"code":"7697936","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Chest Angiography","code_information":[{"code":"7697939","type":"CDM"},{"code":"350","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":3077.0,"discounted_cash":1230.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Cisternography","code_information":[{"code":"7697942","type":"CDM"},{"code":"351","type":"RC"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":3120.0,"discounted_cash":1248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Guide Chest Tube Insertion","code_information":[{"code":"7697945","type":"CDM"},{"code":"350","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Guide Needle Placement","code_information":[{"code":"7697948","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Guide Nerve Root Injection","code_information":[{"code":"7697951","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Heart Str/Mph With Contrast Chd","code_information":[{"code":"7697954","type":"CDM"},{"code":"359","type":"RC"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":1419.0,"discounted_cash":567.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Heart Str/Mph/Fnt W/Contrast","code_information":[{"code":"7697957","type":"CDM"},{"code":"359","type":"RC"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1712.0,"discounted_cash":684.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Internal Auditory Canals W/ Contrast","code_information":[{"code":"7697960","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Int Auditory Canals W/ + W/O Contrast","code_information":[{"code":"7697963","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.0,"discounted_cash":857.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Internal Auditory Canals W/O Contrast","code_information":[{"code":"7697966","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":777.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Pelvis W/ Iv Contrast Only","code_information":[{"code":"7697969","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3206.0,"discounted_cash":1282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Pelvis W/ Oral Contrast Only","code_information":[{"code":"7697972","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Sinus Limited","code_information":[{"code":"7697993","type":"CDM"},{"code":"350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1301.0,"discounted_cash":520.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Sinus Surgical Protocol","code_information":[{"code":"7697996","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Temporal Bone W/ Contrast","code_information":[{"code":"7697999","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Temporal Bone W/ And W/O Contrast","code_information":[{"code":"7698002","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.0,"discounted_cash":857.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Temporal Bone W/O Contrast","code_information":[{"code":"7698005","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":777.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Abd Aortagram W/ Runoff Bilateral","code_information":[{"code":"7698017","type":"CDM"},{"code":"323","type":"RC"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Chest Tube Insertion","code_information":[{"code":"7698020","type":"CDM"},{"code":"320","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Feeding Tube Placement","code_information":[{"code":"7698023","type":"CDM"},{"code":"320","type":"RC"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Gallbladder Biopsy","code_information":[{"code":"7698026","type":"CDM"},{"code":"329","type":"RC"},{"code":"37200","type":"HCPCS"}],"standard_charges":[{"gross_charge":9762.0,"discounted_cash":3904.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Level 1 Established Patient","code_information":[{"code":"7698032","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":153.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Level 2 W/ Radiologist","code_information":[{"code":"7698035","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Mediport Injection","code_information":[{"code":"7698038","type":"CDM"},{"code":"360","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":431.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Mesenteric Arteriogram","code_information":[{"code":"7698041","type":"CDM"},{"code":"323","type":"RC"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.0,"discounted_cash":4566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Nerve Root Injection Thoracic/Lumbar","code_information":[{"code":"7698044","type":"CDM"},{"code":"320","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2453.0,"discounted_cash":981.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Percu Drainage Catheter Placement","code_information":[{"code":"7698047","type":"CDM"},{"code":"320","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Percutaneous Ureteral Stent Placement","code_information":[{"code":"7698053","type":"CDM"},{"code":"360","type":"RC"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":8193.0,"discounted_cash":3277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Peripherally Inserted Central Cath","code_information":[{"code":"7698056","type":"CDM"},{"code":"320","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3448.0,"discounted_cash":1379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Shuntogram Non Vascular","code_information":[{"code":"7698059","type":"CDM"},{"code":"320","type":"RC"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Splenography","code_information":[{"code":"7698062","type":"CDM"},{"code":"320","type":"RC"},{"code":"75810","type":"HCPCS"}],"standard_charges":[{"gross_charge":10749.0,"discounted_cash":4299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Steroid Injection Lumbar","code_information":[{"code":"7698065","type":"CDM"},{"code":"320","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":1898.0,"discounted_cash":759.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Temporary Dialysis Catheter Placement","code_information":[{"code":"7698068","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Venography Extremity Unilateral","code_information":[{"code":"7698071","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3428.0,"discounted_cash":1371.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mg Breast Dig Diagnostic Call Back Left","code_information":[{"code":"7698077","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Mg Breast Dig Diagnostic Call Back Right","code_information":[{"code":"7698080","type":"CDM"},{"code":"401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Mg Breast Digital Mammogram W/ Implant","code_information":[{"code":"7698083","type":"CDM"},{"code":"403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mg Breast Seed Localization","code_information":[{"code":"7698086","type":"CDM"},{"code":"361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.0,"discounted_cash":999.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mr Lower Joint Arthrogram","code_information":[{"code":"7698092","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":4222.0,"discounted_cash":1688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Complete W/ Contrast","code_information":[{"code":"7698104","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":1437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Complete W/ + W/O Contrast","code_information":[{"code":"7698107","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":5060.0,"discounted_cash":2024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Spine Complete W/O Contrast","code_information":[{"code":"7698110","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mr Neck W/ Contrast","code_information":[{"code":"7698113","type":"CDM"},{"code":"611","type":"RC"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":1437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mr Neck W/ And W/O Contrast","code_information":[{"code":"7698116","type":"CDM"},{"code":"611","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":5058.0,"discounted_cash":2023.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mr Neck W/O Contrast","code_information":[{"code":"7698119","type":"CDM"},{"code":"611","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":4081.0,"discounted_cash":1632.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mr Orbits W/ Contrast","code_information":[{"code":"7698122","type":"CDM"},{"code":"611","type":"RC"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":1437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mr Orbits W/ And W/O Contrast","code_information":[{"code":"7698125","type":"CDM"},{"code":"611","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":5058.0,"discounted_cash":2023.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mr Orbits W/O Contrast","code_information":[{"code":"7698128","type":"CDM"},{"code":"611","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":4081.0,"discounted_cash":1632.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mrv Brain W/O Contrast","code_information":[{"code":"7698146","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3334.0,"discounted_cash":1333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mrv Neck W/O Contrast","code_information":[{"code":"7698152","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":2955.0,"discounted_cash":1182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Py Test","code_information":[{"code":"7698161","type":"CDM"},{"code":"340","type":"RC"},{"code":"78267","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":198.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Thyroid Treatment Oral","code_information":[{"code":"7698164","type":"CDM"},{"code":"342","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.0,"discounted_cash":500.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Asp/Inject Renal Cyst/Pelvis Left","code_information":[{"code":"7698167","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Asp/Inject Renal Cyst/Pelvis Right","code_information":[{"code":"7698170","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Doppler Major Vessels","code_information":[{"code":"7698173","type":"CDM"},{"code":"921","type":"RC"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Doppler Organs Complete","code_information":[{"code":"7698176","type":"CDM"},{"code":"921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1831.0,"discounted_cash":732.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Fetal Survey","code_information":[{"code":"7698182","type":"CDM"},{"code":"402","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"discounted_cash":570.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Guide Renal Stent Placement","code_information":[{"code":"7698185","type":"CDM"},{"code":"402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Guide Seed/Clip/Wire/Needle Placement","code_information":[{"code":"7698188","type":"CDM"},{"code":"361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2498.0,"discounted_cash":999.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Pancreas Biopsy","code_information":[{"code":"7698194","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Pelvis Limited Non Ob","code_information":[{"code":"7698197","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Renal Bilateral","code_information":[{"code":"7698206","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1602.0,"discounted_cash":640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Renal And/Or Aorta Limited","code_information":[{"code":"7698209","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Specimen Ultrasound","code_information":[{"code":"7698212","type":"CDM"},{"code":"320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1417.0,"discounted_cash":566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Thyroid Biopsy","code_information":[{"code":"7698215","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Abdomen Colon Transit Study Addl Kub","code_information":[{"code":"7698224","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Abd Colon Transit Study Initial Kub","code_information":[{"code":"7698227","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Abd Colon Transit Study Initial Kub - Report","code_information":[{"code":"7698229","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Abdomen Flat And Erect","code_information":[{"code":"7698230","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":45.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":45.19,"discounted_cash":18.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Abdomen Post Or Cholangio T-Tube","code_information":[{"code":"7698236","type":"CDM"},{"code":"320","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Abdomen Upright Only","code_information":[{"code":"7698239","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.85,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":26.85,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Abdomen For Tube Placement","code_information":[{"code":"7698242","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Abdomen For Tube Placement - Report","code_information":[{"code":"7698244","type":"CDM"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr C Arm </= 1 Hour","code_information":[{"code":"7698245","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Chest Dhec One View","code_information":[{"code":"7698248","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Chest Dhec Two Views","code_information":[{"code":"7698251","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Chest Dhec Two Views - Report","code_information":[{"code":"7698253","type":"CDM"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Chest Fluoroscopy","code_information":[{"code":"7698254","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Cystogram In Or","code_information":[{"code":"7698260","type":"CDM"},{"code":"320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Elbow Arthrography","code_information":[{"code":"7698263","type":"CDM"},{"code":"320","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Fine Needle Aspiration W/ Guidance","code_information":[{"code":"7698266","type":"CDM"},{"code":"361","type":"RC"},{"code":"10007","type":"HCPCS"}],"standard_charges":[{"gross_charge":1779.0,"discounted_cash":711.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Fistulagram","code_information":[{"code":"7698269","type":"CDM"},{"code":"320","type":"RC"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":343.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Fluoro Guide For Vascular Device","code_information":[{"code":"7698272","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Guide Chest Tube Insertion","code_information":[{"code":"7698275","type":"CDM"},{"code":"320","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Heel Limited 1 View Left","code_information":[{"code":"7698278","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"52|LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","modifiers":"52|LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"52|LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"52|LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Heel Limited 1 View Right","code_information":[{"code":"7698281","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"52|RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","modifiers":"52|RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"52|RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":51.63,"discounted_cash":20.65,"setting":"both","modifiers":"52|RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Hip Arthrography","code_information":[{"code":"7698287","type":"CDM"},{"code":"320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.0,"discounted_cash":590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Inject Single Tendon Sheath","code_information":[{"code":"7698290","type":"CDM"},{"code":"320","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":387.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Lumbar Puncture Therapeutic","code_information":[{"code":"7698299","type":"CDM"},{"code":"320","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.0,"discounted_cash":855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Navicular 2 Views Left","code_information":[{"code":"7698302","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.09,"discounted_cash":15.64,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":39.09,"discounted_cash":15.64,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Navicular 2 Views Right","code_information":[{"code":"7698305","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.09,"discounted_cash":15.64,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":39.09,"discounted_cash":15.64,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Patella 1 Or 2 Views Left","code_information":[{"code":"7698311","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.3,"discounted_cash":22.52,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.3,"discounted_cash":22.52,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Patella 1 Or 2 Views Right","code_information":[{"code":"7698314","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.3,"discounted_cash":22.52,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":56.3,"discounted_cash":22.52,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Pelvis Judet 2 Views","code_information":[{"code":"7698320","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":43.0,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":353.0,"discounted_cash":141.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":43.12,"discounted_cash":17.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Shoulder Arthrography","code_information":[{"code":"7698329","type":"CDM"},{"code":"320","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1423.0,"discounted_cash":569.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Shoulder Bilateral 2 Views Each","code_information":[{"code":"7698332","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":720.0,"discounted_cash":288.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Xr Urethrogram","code_information":[{"code":"7698340","type":"CDM"},{"code":"320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mg Breast Tomo 3D Dig Bilat Screening","code_information":[{"code":"7698376","type":"CDM"},{"code":"403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Bone Scan Whole Body","code_information":[{"code":"7698385","type":"CDM"},{"code":"341","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":558.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Guided Needle Placement","code_information":[{"code":"7698388","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Femur Left","code_information":[{"code":"7698393","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.39,"discounted_cash":24.96,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":62.39,"discounted_cash":24.96,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Femur Right","code_information":[{"code":"7698395","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.39,"discounted_cash":24.96,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":62.39,"discounted_cash":24.96,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Hip Bilateral And Pelvis Adult 5 Vws","code_information":[{"code":"7698397","type":"CDM"},{"code":"320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.04,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":77.04,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Hip Complete 2+ Views Left","code_information":[{"code":"7698399","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":469.0,"discounted_cash":187.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Hip Complete 2+ Views Right","code_information":[{"code":"7698401","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":469.0,"discounted_cash":187.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Spine Scoliosis Study Standing","code_information":[{"code":"7698403","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":93.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":140.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":93.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 1 After Hours","code_information":[{"code":"7698467","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":49.69,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Inj Admin Charge 96372 - Amb Only Inj Med Admin Charge","code_information":[{"code":"7698560","type":"CDM"},{"code":"510","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":115.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Emergency Dept Visit Lvl 1","code_information":[{"code":"7699164","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Dept Visit Lvl 2","code_information":[{"code":"7699165","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":355.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Dept Visit Lvl 3","code_information":[{"code":"7699166","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Dept Visit Lvl 4","code_information":[{"code":"7699167","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.0,"discounted_cash":678.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Dept Visit Lvl 5","code_information":[{"code":"7699168","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.74,"discounted_cash":141.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":2904.0,"discounted_cash":1161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Critical Care 30-74 Min","code_information":[{"code":"7699169","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3222.0,"discounted_cash":1288.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Critical Care Ea Addl 30 Min","code_information":[{"code":"7699170","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":381.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Inf Hydration;Ea Addl Hr","code_information":[{"code":"7699174","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Therapy Up To 1 Hr","code_information":[{"code":"7699175","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.0,"discounted_cash":383.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Therapy Each Addl Hr","code_information":[{"code":"7699176","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Inf Addl Seq Inf Up To 1Hr","code_information":[{"code":"7699177","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Inf Concurrent","code_information":[{"code":"7699178","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Administration Im/Sq Therapeut","code_information":[{"code":"7699179","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Op Tx/Pro/Dx Ivp-1St Drug","code_information":[{"code":"7699181","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Op Tx/Pro/Dx Ivp-Ea Addl Drg","code_information":[{"code":"7699182","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ea Addl Ivp Same Subst >30 Min","code_information":[{"code":"7699183","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blood Transfusion","code_information":[{"code":"7699184","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Idadd(Bld)","code_information":[{"code":"7699187","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Idcampy","code_information":[{"code":"7699190","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Idadd(Ur)","code_information":[{"code":"7699191","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Idadd(N-Ur)","code_information":[{"code":"7699192","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Idstaph(Bld)","code_information":[{"code":"7699195","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Vitek (Bld)","code_information":[{"code":"7699196","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Idstaph(Ur)","code_information":[{"code":"7699197","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Idstaph(N-Ur)","code_information":[{"code":"7699198","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Vitek (N-Ur)","code_information":[{"code":"7699199","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Vitek Ybc (Ur)","code_information":[{"code":"7699200","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Vitek Ybc-Other","code_information":[{"code":"7699201","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Vitek Ybc (Fung)","code_information":[{"code":"7699202","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Vitek Ybc (Bld)","code_information":[{"code":"7699203","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Vitek (Ur)","code_information":[{"code":"7699204","type":"CDM"},{"code":"300","type":"RC"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Vgn80","code_information":[{"code":"7699205","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Id Gram Positive Vgp St01","code_information":[{"code":"7699206","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Id Gram Positive Ast Gp75","code_information":[{"code":"7699207","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunoglobulins Panel Serum-(7083)","code_information":[{"code":"7699211","type":"CDM"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urine Protein Total Lvl","code_information":[{"code":"7699223","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Upper Gi W/ Air W/ Small Bowel","code_information":[{"code":"7699278","type":"CDM"},{"code":"320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immunoglobulin G, Serum","code_information":[{"code":"7699294","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fungus Id","code_information":[{"code":"7699303","type":"CDM"},{"code":"300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fastidious Organism Id","code_information":[{"code":"7699347","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatinine Poc","code_information":[{"code":"7699351","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Inf Hydration 31 Mn To 1 Hr","code_information":[{"code":"7699407","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fluzone High Dose Iiiv4 90630","code_information":[{"code":"7699948","type":"CDM"},{"code":"510","type":"RC"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":20.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hepatitis A Vacc Ped/Adol 2 Dose 90633","code_information":[{"code":"7699950","type":"CDM"},{"code":"510","type":"RC"},{"code":"90633","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":52.78,"discounted_cash":21.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hep A/Hep B Vacc Adult Im 90636","code_information":[{"code":"7699951","type":"CDM"},{"code":"510","type":"RC"},{"code":"90636","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":155.25,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hpv4 Vaccine 3 Dose 90649","code_information":[{"code":"7699953","type":"CDM"},{"code":"510","type":"RC"},{"code":"90649","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.94,"discounted_cash":117.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":293.94,"discounted_cash":117.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hpv Vaccine (Gardasil) Nonvalent 90651","code_information":[{"code":"7699954","type":"CDM"},{"code":"510","type":"RC"},{"code":"90651","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.88,"discounted_cash":93.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":232.88,"discounted_cash":93.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Iiv3 Vacc No Prsv 3 Yrs Plus Im 90656","code_information":[{"code":"7699955","type":"CDM"},{"code":"510","type":"RC"},{"code":"90656","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.7,"discounted_cash":17.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":44.7,"discounted_cash":17.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Iiv3 Vaccine 3 Yrs Plus  Im 90658","code_information":[{"code":"7699956","type":"CDM"},{"code":"90658","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.98,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Laiv4 Vaccine Intranasal 90672","code_information":[{"code":"7699958","type":"CDM"},{"code":"510","type":"RC"},{"code":"90672","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.05,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":31.05,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Riv3 Vaccine No Preserv Im 90673","code_information":[{"code":"7699959","type":"CDM"},{"code":"90673","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.58,"discounted_cash":18.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Dtap-Ipv Vacc 4-6 Yr 90696","code_information":[{"code":"7699964","type":"CDM"},{"code":"510","type":"RC"},{"code":"90696","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.02,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":119.02,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Dtap Vaccine < 7 Yrs 90700","code_information":[{"code":"7699966","type":"CDM"},{"code":"510","type":"RC"},{"code":"90700","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":38.3,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Poliovirus Ipv 90713","code_information":[{"code":"7699969","type":"CDM"},{"code":"510","type":"RC"},{"code":"90713","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":44.5,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Tdap Vaccine 7 Yrs/> 90715","code_information":[{"code":"7699971","type":"CDM"},{"code":"510","type":"RC"},{"code":"90715","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.1,"discounted_cash":24.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":62.1,"discounted_cash":24.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Var Vaccine Live 90716","code_information":[{"code":"7699972","type":"CDM"},{"code":"510","type":"RC"},{"code":"90716","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":155.25,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Dtap-Hep B-Ipv Vaccine 90723","code_information":[{"code":"7699973","type":"CDM"},{"code":"510","type":"RC"},{"code":"90723","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.58,"discounted_cash":18.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":46.58,"discounted_cash":18.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Menacwy Vaccine 90734","code_information":[{"code":"7699975","type":"CDM"},{"code":"90734","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":175.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hep B Vacc 3 Dose Adult Im 90746","code_information":[{"code":"7699977","type":"CDM"},{"code":"510","type":"RC"},{"code":"90746","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.32,"discounted_cash":39.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":98.32,"discounted_cash":39.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Special Eye Evaluation 92060","code_information":[{"code":"7699979","type":"CDM"},{"code":"510","type":"RC"},{"code":"92060","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.43,"discounted_cash":64.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":96.26,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":160.43,"discounted_cash":64.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Nasopharyngoscopy 92511","code_information":[{"code":"7699980","type":"CDM"},{"code":"510","type":"RC"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.52,"discounted_cash":171.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":257.71,"discounted_cash":103.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":429.52,"discounted_cash":171.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Basic Vestibular Evaluation","code_information":[{"code":"7699981","type":"CDM"},{"code":"510","type":"RC"},{"code":"92540","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.72,"discounted_cash":138.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":208.04,"discounted_cash":83.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":139.0,"discounted_cash":55.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":346.72,"discounted_cash":138.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Spontaneous Nystagmus Test 92541","code_information":[{"code":"7699982","type":"CDM"},{"code":"92541","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.06,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Positional Nystagmus Test 92542","code_information":[{"code":"7699983","type":"CDM"},{"code":"92542","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.05,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Optokinetic Nystagmus Test 92544","code_information":[{"code":"7699984","type":"CDM"},{"code":"92544","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.32,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Oscillating Tracking Test 92545","code_information":[{"code":"7699985","type":"CDM"},{"code":"92545","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.17,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Pure Tone Hearing Test Air 92551","code_information":[{"code":"7699986","type":"CDM"},{"code":"92551","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Pure Tone Audiometry Air 92552","code_information":[{"code":"7699987","type":"CDM"},{"code":"92552","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.8,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":289.8,"discounted_cash":115.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Comprehensive Hearing Test 92557","code_information":[{"code":"7699988","type":"CDM"},{"code":"92557","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.25,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":362.25,"discounted_cash":144.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Tympanometry 92567","code_information":[{"code":"7699989","type":"CDM"},{"code":"92567","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.68,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":108.68,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Visual Audiometry (Vra) 92579","code_information":[{"code":"7699990","type":"CDM"},{"code":"92579","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.88,"discounted_cash":30.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Evoked Auditory Test Limited 92587","code_information":[{"code":"7699992","type":"CDM"},{"code":"510","type":"RC"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.52,"discounted_cash":254.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":381.92,"discounted_cash":152.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":255.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":636.52,"discounted_cash":254.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Evoke Auditory Test Complete 92588","code_information":[{"code":"7699993","type":"CDM"},{"code":"92588","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.41,"discounted_cash":51.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tinnitus Assessment 92625","code_information":[{"code":"7699995","type":"CDM"},{"code":"92625","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.33,"discounted_cash":50.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Misc. Audiology Procedure 92700","code_information":[{"code":"7699996","type":"CDM"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Amb Electrocardiogram Complete 93000 Bce","code_information":[{"code":"7699997","type":"CDM"},{"code":"93000","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":56.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Electrocardiogram Tracing 93005","code_information":[{"code":"7699998","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.8,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Ecg Monit/Rprt Up To 48 Hrs 93227","code_information":[{"code":"7700002","type":"CDM"},{"code":"93227","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.01,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Remote 30 Day Ecg Rev/Report 93228","code_information":[{"code":"7700003","type":"CDM"},{"code":"510","type":"RC"},{"code":"93228","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.16,"discounted_cash":21.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Remote 30 Day Ecg Rev/Report 93270","code_information":[{"code":"7700004","type":"CDM"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.91,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Event Monitor Reading-Physician  93272","code_information":[{"code":"7700005","type":"CDM"},{"code":"93272","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.96,"discounted_cash":20.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Pm Device Progr Eval Sngl 93279","code_information":[{"code":"7700006","type":"CDM"},{"code":"510","type":"RC"},{"code":"93279","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.43,"discounted_cash":39.37,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":59.06,"discounted_cash":23.62,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":65.69,"discounted_cash":26.28,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Pm Device Progr Eval Dual 93280","code_information":[{"code":"7700007","type":"CDM"},{"code":"480","type":"RC"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.38,"discounted_cash":46.55,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":69.83,"discounted_cash":27.93,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":78.55,"discounted_cash":31.42,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Pm Device Progr Eval Multi 93281","code_information":[{"code":"7700008","type":"CDM"},{"code":"510","type":"RC"},{"code":"93281","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.54,"discounted_cash":54.22,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":81.33,"discounted_cash":32.53,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":68.0,"discounted_cash":27.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":91.61,"discounted_cash":36.64,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Prgrmg Eval Implantable Dfb 93283","code_information":[{"code":"7700009","type":"CDM"},{"code":"510","type":"RC"},{"code":"93283","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.83,"discounted_cash":65.13,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":97.7,"discounted_cash":39.08,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":117.51,"discounted_cash":47.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Prgrmg Eval Implantable Dfb 93284","code_information":[{"code":"7700010","type":"CDM"},{"code":"510","type":"RC"},{"code":"93284","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.08,"discounted_cash":71.63,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":107.45,"discounted_cash":42.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":127.66,"discounted_cash":51.06,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Ilr Device Eval Progr 93285","code_information":[{"code":"7700011","type":"CDM"},{"code":"510","type":"RC"},{"code":"93285","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.69,"discounted_cash":33.48,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":50.21,"discounted_cash":20.08,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":53.05,"discounted_cash":21.22,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Pm Device Eval In Person 93288","code_information":[{"code":"7700012","type":"CDM"},{"code":"510","type":"RC"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.27,"discounted_cash":29.71,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":44.56,"discounted_cash":17.82,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":30.0,"discounted_cash":12.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":43.68,"discounted_cash":17.47,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Interrogation Device Eval Heart 93289","code_information":[{"code":"7700013","type":"CDM"},{"code":"510","type":"RC"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.27,"discounted_cash":52.11,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":78.16,"discounted_cash":31.26,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":52.0,"discounted_cash":20.8,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":92.63,"discounted_cash":37.05,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Icm Device Eval 93290","code_information":[{"code":"7700014","type":"CDM"},{"code":"480","type":"RC"},{"code":"93290","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":34.0,"discounted_cash":13.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":43.74,"discounted_cash":17.5,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Pm Phone R-Strip Device Eval 93293","code_information":[{"code":"7700015","type":"CDM"},{"code":"510","type":"RC"},{"code":"93293","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.25,"discounted_cash":41.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":160.88,"discounted_cash":64.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":107.0,"discounted_cash":42.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":104.25,"discounted_cash":41.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Pm Device Interrogate Remote 93294","code_information":[{"code":"7700016","type":"CDM"},{"code":"93294","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.79,"discounted_cash":27.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Tte W/Doppler Complete 93306","code_information":[{"code":"7700017","type":"CDM"},{"code":"510","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.78,"discounted_cash":176.71,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":128.71,"discounted_cash":51.48,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Tte F-Up Or Lmtd 93308","code_information":[{"code":"7700018","type":"CDM"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.13,"discounted_cash":96.45,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":171.81,"discounted_cash":68.72,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Review Patient Spirometry 94016","code_information":[{"code":"7700020","type":"CDM"},{"code":"94016","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.96,"discounted_cash":20.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Airway Inhalation Treatment 94640","code_information":[{"code":"7700023","type":"CDM"},{"code":"510","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.13,"discounted_cash":14.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":35.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Measure Blood Oxygen Level, Single 94760","code_information":[{"code":"7700028","type":"CDM"},{"code":"510","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":9.32,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":6.0,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":15.52,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Measure Blood Oxygen Level, Multiple 94761","code_information":[{"code":"7700029","type":"CDM"},{"code":"510","type":"RC"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.36,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":5.61,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":3.74,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":9.36,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Polysom 6/>Yrs Cpap 4/> Parm 95811","code_information":[{"code":"7700032","type":"CDM"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":1261.06,"discounted_cash":504.42,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":256.6,"discounted_cash":102.64,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Muscle Test One Limb 95860","code_information":[{"code":"7700033","type":"CDM"},{"code":"510","type":"RC"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.95,"discounted_cash":96.38,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":144.03,"discounted_cash":57.61,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Muscle Test Hemidiaphragm 95866","code_information":[{"code":"7700034","type":"CDM"},{"code":"922","type":"RC"},{"code":"95866","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.37,"discounted_cash":104.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":157.42,"discounted_cash":62.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":105.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":262.37,"discounted_cash":104.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Electrical Stim Guided (Botox) 95873","code_information":[{"code":"7700035","type":"CDM"},{"code":"510","type":"RC"},{"code":"95873","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.27,"discounted_cash":58.11,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":87.16,"discounted_cash":34.86,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":58.0,"discounted_cash":23.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":41.41,"discounted_cash":16.56,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Musc Tst Done W/ Nerv Tst Lim 95885","code_information":[{"code":"7700036","type":"CDM"},{"code":"922","type":"RC"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.72,"discounted_cash":55.89,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":83.84,"discounted_cash":33.54,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":37.91,"discounted_cash":15.16,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Musc Test Done W/N Test Comp 95886","code_information":[{"code":"7700037","type":"CDM"},{"code":"922","type":"RC"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.94,"discounted_cash":93.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":140.97,"discounted_cash":56.39,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":94.0,"discounted_cash":37.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":92.91,"discounted_cash":37.16,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Musc Tst Done W/N Tst Nonext 95887","code_information":[{"code":"7700038","type":"CDM"},{"code":"922","type":"RC"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.09,"discounted_cash":64.04,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":96.06,"discounted_cash":38.42,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":77.09,"discounted_cash":30.84,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Nrv Cndj Tst 3-4 Studies 95908","code_information":[{"code":"7700039","type":"CDM"},{"code":"510","type":"RC"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.08,"discounted_cash":98.43,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":147.65,"discounted_cash":59.06,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Nrv Cndj Tst 5-6 Studies 95909","code_information":[{"code":"7700040","type":"CDM"},{"code":"922","type":"RC"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.66,"discounted_cash":116.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":263.02,"discounted_cash":105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":175.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":291.66,"discounted_cash":116.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Nrv Cndj Tst 7-8 Studies 95910","code_information":[{"code":"7700041","type":"CDM"},{"code":"922","type":"RC"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.44,"discounted_cash":154.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":232.47,"discounted_cash":92.99,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":271.19,"discounted_cash":108.48,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Nrv Cndj Tst 9-10 Studies 95911","code_information":[{"code":"7700042","type":"CDM"},{"code":"922","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.65,"discounted_cash":184.66,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":276.99,"discounted_cash":110.8,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":271.18,"discounted_cash":108.47,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Nrv Cndj Tst 11-12 Studies 95912","code_information":[{"code":"7700043","type":"CDM"},{"code":"922","type":"RC"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.03,"discounted_cash":206.41,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":309.62,"discounted_cash":123.85,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":206.0,"discounted_cash":82.4,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":321.92,"discounted_cash":128.77,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Nrv Cndj Tst 13> Studies 95913","code_information":[{"code":"7700044","type":"CDM"},{"code":"922","type":"RC"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.89,"discounted_cash":234.36,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":351.54,"discounted_cash":140.62,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":234.0,"discounted_cash":93.6,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":379.95,"discounted_cash":151.98,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Visual Evoked Potential Test 95930","code_information":[{"code":"7700045","type":"CDM"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.43,"discounted_cash":98.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Blink Reflex Test 95933","code_information":[{"code":"7700046","type":"CDM"},{"code":"95933","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.05,"discounted_cash":65.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Neuromuscular Junction Test 95937","code_information":[{"code":"7700047","type":"CDM"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.41,"discounted_cash":64.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Inf Hiv Inf Initial 31 To 60 Min 96360","code_information":[{"code":"7700051","type":"CDM"},{"code":"510","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Ther Proph Diag Inj Sc Im 96372","code_information":[{"code":"7700052","type":"CDM"},{"code":"510","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Ther Proph Diag Inj Iv Push 96374","code_information":[{"code":"7700053","type":"CDM"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.28,"discounted_cash":43.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Administration Pneumococcal Vacc G0009","code_information":[{"code":"7700055","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.68,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Flu Vacc Split 3 Yrs & >Im Fluzone Q2038","code_information":[{"code":"7700062","type":"CDM"},{"code":"510","type":"RC"},{"code":"Q2038","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.05,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":31.05,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Perflutren Lipid Microsphers Mi Q9957","code_information":[{"code":"7700063","type":"CDM"},{"code":"Q9957","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.92,"discounted_cash":46.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Adjust Gi Band Diam Via Sc Port S2083","code_information":[{"code":"7700064","type":"CDM"},{"code":"S2083","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.25,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Wrist Brace S8451","code_information":[{"code":"7700065","type":"CDM"},{"code":"S8451","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Dressing Change Not For Burn 15852","code_information":[{"code":"7700071","type":"CDM"},{"code":"15852","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.7,"discounted_cash":38.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Intranasal Biopsy 30100","code_information":[{"code":"7700072","type":"CDM"},{"code":"30100","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.1,"discounted_cash":55.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Nasal Endocsopy Dx 31231","code_information":[{"code":"7700073","type":"CDM"},{"code":"510","type":"RC"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.18,"discounted_cash":167.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":251.5,"discounted_cash":100.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":419.18,"discounted_cash":167.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Endoscopy Debridement 31237","code_information":[{"code":"7700074","type":"CDM"},{"code":"510","type":"RC"},{"code":"31237","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":293.4,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":196.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":3239.55,"discounted_cash":1295.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Remove Pharynx Foreign Body 42809","code_information":[{"code":"7700075","type":"CDM"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.45,"discounted_cash":108.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Colonoscopy And Biopsy 45380","code_information":[{"code":"7700076","type":"CDM"},{"code":"45380","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.25,"discounted_cash":260.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Destruction Anal Lesion(S) 46900","code_information":[{"code":"7700077","type":"CDM"},{"code":"510","type":"RC"},{"code":"46900","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.08,"discounted_cash":308.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":462.64,"discounted_cash":185.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":308.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":771.08,"discounted_cash":308.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Cystometrogram W/Vp 51728","code_information":[{"code":"7700078","type":"CDM"},{"code":"510","type":"RC"},{"code":"51728","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.89,"discounted_cash":245.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":367.73,"discounted_cash":147.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":245.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Cystometrogram W/Vp & Up 51729","code_information":[{"code":"7700079","type":"CDM"},{"code":"510","type":"RC"},{"code":"51729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1361.02,"discounted_cash":544.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":816.62,"discounted_cash":326.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1361.02,"discounted_cash":544.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Electro-Uroflowmetry First 51741","code_information":[{"code":"7700080","type":"CDM"},{"code":"510","type":"RC"},{"code":"51741","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.42,"discounted_cash":146.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":220.46,"discounted_cash":88.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":367.42,"discounted_cash":146.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Anal/Urinary Muscle Study 51784","code_information":[{"code":"7700081","type":"CDM"},{"code":"510","type":"RC"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.84,"discounted_cash":150.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":226.11,"discounted_cash":90.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":376.84,"discounted_cash":150.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Intraabdominal Pressure Test 51797","code_information":[{"code":"7700082","type":"CDM"},{"code":"510","type":"RC"},{"code":"51797","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.57,"discounted_cash":87.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":131.14,"discounted_cash":52.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":87.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":218.57,"discounted_cash":87.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Aminophyllin Up To 250 Mg J0280","code_information":[{"code":"7700084","type":"CDM"},{"code":"J0280","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Dipyriadamole Per 10 Mg J1245","code_information":[{"code":"7700093","type":"CDM"},{"code":"J1245","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Inj Lincomycin Hcl To 300 Mg J2010","code_information":[{"code":"7700097","type":"CDM"},{"code":"J2010","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.7,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Mirena Intrauterine Contraceptive J7298","code_information":[{"code":"7700110","type":"CDM"},{"code":"J7298","type":"HCPCS"}],"standard_charges":[{"gross_charge":2312.0,"discounted_cash":924.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Intrauterine Copper Contraceptive J7300","code_information":[{"code":"7700111","type":"CDM"},{"code":"J7300","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.98,"discounted_cash":366.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Skyla Intrauterine Device J7301","code_information":[{"code":"7700112","type":"CDM"},{"code":"J7301","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.38,"discounted_cash":382.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Essure A4264","code_information":[{"code":"7700121","type":"CDM"},{"code":"A4264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1863.0,"discounted_cash":745.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Surgical Trays A4550","code_information":[{"code":"7700122","type":"CDM"},{"code":"A4550","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Dome&Mouthpece W/Sm Vol Us Neb A7016","code_information":[{"code":"7700123","type":"CDM"},{"code":"A7016","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Technetium Tc-99M Sestamibi, Diag A9500","code_information":[{"code":"7700124","type":"CDM"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.78,"discounted_cash":151.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Echocardiography Contrast A9700","code_information":[{"code":"7700125","type":"CDM"},{"code":"A9700","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.2,"discounted_cash":132.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"X-Ray, Unilat Ribs/Chest 71101","code_information":[{"code":"7700128","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.44,"discounted_cash":16.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":42.44,"discounted_cash":16.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Neck Spine 2V-3V 72040","code_information":[{"code":"7700130","type":"CDM"},{"code":"510","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.09,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":41.0,"discounted_cash":16.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":41.09,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, L-S Spine 2V/3V 72100","code_information":[{"code":"7700133","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.72,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":43.72,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Shoulder 3V 73030","code_information":[{"code":"7700138","type":"CDM"},{"code":"510","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.44,"discounted_cash":18.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":36.35,"discounted_cash":14.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Hand 3V 73130","code_information":[{"code":"7700143","type":"CDM"},{"code":"510","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.34,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":40.34,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Hip, Unil Pelvis, 2V-3V 73502","code_information":[{"code":"7700145","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":56.64,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Hip 73510","code_information":[{"code":"7700146","type":"CDM"}],"standard_charges":[{"gross_charge":48.46,"discounted_cash":19.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":48.46,"discounted_cash":19.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray, Knee 3V 73562","code_information":[{"code":"7700150","type":"CDM"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.99,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":45.99,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Mammogram Of Both Breasts 77056","code_information":[{"code":"7700161","type":"CDM"}],"standard_charges":[{"gross_charge":224.62,"discounted_cash":89.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Drug Screen Any Number Of Drug Classes 80300","code_information":[{"code":"7700163","type":"CDM"}],"standard_charges":[{"gross_charge":41.4,"discounted_cash":16.56,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Microalbumin Quantitative 82043","code_information":[{"code":"7700165","type":"CDM"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.33,"discounted_cash":6.53,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Assay Glucose Blood Quant 82947","code_information":[{"code":"7700166","type":"CDM"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.08,"discounted_cash":12.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"H Pylori (C-13) Breath 83013","code_information":[{"code":"7700167","type":"CDM"},{"code":"510","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.63,"discounted_cash":49.05,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"H Pylori Blood","code_information":[{"code":"7700169","type":"CDM"},{"code":"86318","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.27,"discounted_cash":19.71,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Complex Cystometrogram 51726","code_information":[{"code":"7700170","type":"CDM"},{"code":"512","type":"RC"},{"code":"51726","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.88,"discounted_cash":205.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":307.73,"discounted_cash":123.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Complex Cystometrogram W/ Upp 51727","code_information":[{"code":"7700171","type":"CDM"},{"code":"510","type":"RC"},{"code":"51727","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.83,"discounted_cash":243.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":364.7,"discounted_cash":145.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":243.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Flu Vaccine 6-35 Mo 90657","code_information":[{"code":"7700176","type":"CDM"},{"code":"90657","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.22,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Immunization Admin 1St < 18 Yrs 90460","code_information":[{"code":"7700177","type":"CDM"},{"code":"510","type":"RC"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Ea Addt'l Immunization < 18 Yrs 90461","code_information":[{"code":"7700178","type":"CDM"},{"code":"510","type":"RC"},{"code":"90461","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.25,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Ht Muscle Image Spect, Single 78451","code_information":[{"code":"7700179","type":"CDM"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.29,"discounted_cash":271.72,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":137.2,"discounted_cash":54.88,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"3-D Echo 76376","code_information":[{"code":"7700184","type":"CDM"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.25,"discounted_cash":82.1,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"X-Ray, Tibia & Fibula 2V 73590","code_information":[{"code":"7700194","type":"CDM"},{"code":"510","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":32.93,"discounted_cash":13.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"X-Ray Wrist 3V 73100","code_information":[{"code":"7700195","type":"CDM"},{"code":"510","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.09,"discounted_cash":15.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Sedimentation Rate 85651","code_information":[{"code":"7700202","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":12.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Immunization Admin 1St > 18 Yrs 90471","code_information":[{"code":"7700208","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.12,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Neurobehavioral Status Exam 96116","code_information":[{"code":"7700210","type":"CDM"},{"code":"510","type":"RC"},{"code":"96116","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.9,"discounted_cash":70.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":106.14,"discounted_cash":42.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":71.0,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":176.9,"discounted_cash":70.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Sbirt","code_information":[{"code":"7700219","type":"CDM"},{"code":"H0002","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.84,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Telehealth Originating Fee Q3014","code_information":[{"code":"7700221","type":"CDM"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.88,"discounted_cash":10.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Glucose Baseline","code_information":[{"code":"7700280","type":"CDM"},{"code":"300","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose 3 Hour","code_information":[{"code":"7700283","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose 4 Hour","code_information":[{"code":"7700284","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glucose 5 Hour","code_information":[{"code":"7700285","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortisol Baseline","code_information":[{"code":"7700286","type":"CDM"},{"code":"300","type":"RC"},{"code":"80400","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortisol 30 Minute","code_information":[{"code":"7700287","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortisol 1 Hour","code_information":[{"code":"7700288","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Sinus W/ + W/O Contrast","code_information":[{"code":"7700292","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Sinus W/ Contrast","code_information":[{"code":"7700294","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Cervicocerebral","code_information":[{"code":"7700296","type":"CDM"},{"code":"323","type":"RC"},{"code":"36221","type":"HCPCS"}],"standard_charges":[{"gross_charge":11591.0,"discounted_cash":4636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Extremity Bilateral","code_information":[{"code":"7700298","type":"CDM"},{"code":"323","type":"RC"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.0,"discounted_cash":4566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Extremity Left","code_information":[{"code":"7700300","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Extremity Right","code_information":[{"code":"7700302","type":"CDM"},{"code":"323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Pulmonary Bilateral","code_information":[{"code":"7700304","type":"CDM"},{"code":"323","type":"RC"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Pulmonary Left","code_information":[{"code":"7700307","type":"CDM"},{"code":"323","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":10749.0,"discounted_cash":4299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Pulmonary Right","code_information":[{"code":"7700310","type":"CDM"},{"code":"323","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":9347.0,"discounted_cash":3738.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Angiogram Renal Bilateral","code_information":[{"code":"7700313","type":"CDM"},{"code":"320","type":"RC"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.0,"discounted_cash":4566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Aortogram Thoracic W/ Serialography","code_information":[{"code":"7700315","type":"CDM"},{"code":"323","type":"RC"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":7551.0,"discounted_cash":3020.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Fistula Or Sinus Tract Abscess Study","code_information":[{"code":"7700317","type":"CDM"},{"code":"320","type":"RC"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":343.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Gi Tube Placement","code_information":[{"code":"7700319","type":"CDM"},{"code":"320","type":"RC"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Nephrostogram","code_information":[{"code":"7700321","type":"CDM"},{"code":"320","type":"RC"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.0,"discounted_cash":590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Renal Catheter Perc Placement Left","code_information":[{"code":"7700323","type":"CDM"},{"code":"360","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":7324.0,"discounted_cash":2929.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Ir Retrieval Foreign Body Intravasc Perc","code_information":[{"code":"7700327","type":"CDM"},{"code":"360","type":"RC"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":10557.0,"discounted_cash":4222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Tube Or Cath Change","code_information":[{"code":"7700329","type":"CDM"},{"code":"320","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Venogram Cava Inferior","code_information":[{"code":"7700331","type":"CDM"},{"code":"320","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.0,"discounted_cash":4566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ir Venogram Cava Superior","code_information":[{"code":"7700333","type":"CDM"},{"code":"320","type":"RC"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":3221.0,"discounted_cash":1288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mg Stereotactic Localization Bilateral","code_information":[{"code":"7700335","type":"CDM"},{"code":"361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Breast Tumor Localization","code_information":[{"code":"7700337","type":"CDM"},{"code":"341","type":"RC"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Myocardial Infarct Avid Planar","code_information":[{"code":"7700339","type":"CDM"},{"code":"341","type":"RC"},{"code":"78466","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.0,"discounted_cash":584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Thyroid Ca Mets Imaging W/ Addl","code_information":[{"code":"7700341","type":"CDM"},{"code":"341","type":"RC"},{"code":"78020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2276.0,"discounted_cash":910.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Aorta Complete","code_information":[{"code":"7700343","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1602.0,"discounted_cash":640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Aspiration/Inject/Biopsy Left","code_information":[{"code":"7700345","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Us Aspiration/Inject/Biopsy Right","code_information":[{"code":"7700347","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":470.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Us Drainage Abscess Or Cyst","code_information":[{"code":"7700349","type":"CDM"},{"code":"402","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Duplex Hemodialysis Access Flow","code_information":[{"code":"7700351","type":"CDM"},{"code":"921","type":"RC"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Duplex Penile Art/Veins Limited","code_information":[{"code":"7700353","type":"CDM"},{"code":"921","type":"RC"},{"code":"93981","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Thyroid","code_information":[{"code":"7700355","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Arthrogram Ankle","code_information":[{"code":"7700357","type":"CDM"},{"code":"320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Arthrogram Knee","code_information":[{"code":"7700359","type":"CDM"},{"code":"320","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Barium Enema Therapeutic","code_information":[{"code":"7700363","type":"CDM"},{"code":"320","type":"RC"},{"code":"74283","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":272.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Chest 1 View","code_information":[{"code":"7700365","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":25.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":292.0,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":24.82,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Fluoroscopy Up To 1 Hour","code_information":[{"code":"7700367","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Gastrografin Enema","code_information":[{"code":"7700369","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":234.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Gastrografin Swallow","code_information":[{"code":"7700371","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Internal Audio Meati Complete Left","code_information":[{"code":"7700373","type":"CDM"},{"code":"320","type":"RC"},{"code":"70134","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.83,"discounted_cash":25.93,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":390.0,"discounted_cash":156.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":64.83,"discounted_cash":25.93,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Internal Audio Meati Complete Right","code_information":[{"code":"7700375","type":"CDM"},{"code":"320","type":"RC"},{"code":"70134","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.83,"discounted_cash":25.93,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":390.0,"discounted_cash":156.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":64.83,"discounted_cash":25.93,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Knee 4 Views W/ Patella Left","code_information":[{"code":"7700377","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":409.0,"discounted_cash":163.6,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Knee 4 Views W/ Patella Right","code_information":[{"code":"7700379","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":409.0,"discounted_cash":163.6,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Pyelostogram","code_information":[{"code":"7700381","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Spine Cervical Flexion + Extension","code_information":[{"code":"7700383","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.36,"discounted_cash":20.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":41.09,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Spine Single View Specify Level","code_information":[{"code":"7700385","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.06,"discounted_cash":16.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":242.0,"discounted_cash":96.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":42.06,"discounted_cash":16.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Xr Ivp W/ Nephrotomogram","code_information":[{"code":"7700387","type":"CDM"},{"code":"320","type":"RC"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":312.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Venogram Lower Extremity Bilateral","code_information":[{"code":"7700389","type":"CDM"},{"code":"320","type":"RC"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2340.0,"discounted_cash":936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Venogram Lower Extremity Left","code_information":[{"code":"7700391","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3428.0,"discounted_cash":1371.2,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Xr Venogram Lower Extremity Right","code_information":[{"code":"7700393","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3428.0,"discounted_cash":1371.2,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Xr Zygomatic Arches","code_information":[{"code":"7700401","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":491.0,"discounted_cash":196.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":52.58,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Alkaline Phosphatase Isoenzymes","code_information":[{"code":"7700555","type":"CDM"},{"code":"300","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Creatinine (U) (Mass/Vol)","code_information":[{"code":"7700744","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Patient O.D. (Service Comment Interp)","code_information":[{"code":"7701095","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hepatitis B Surface Ag Neut, Ql (Conf)","code_information":[{"code":"7701098","type":"CDM"},{"code":"300","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tot Bilirubin-Liver Fibrosis","code_information":[{"code":"7701196","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ggt-Liver Fibrosis","code_information":[{"code":"7701197","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Alt-Liver Fibrosis","code_information":[{"code":"7701198","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Result Mycobacterium","code_information":[{"code":"7701243","type":"CDM"},{"code":"300","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Psa Total","code_information":[{"code":"7701306","type":"CDM"},{"code":"300","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrocautery Cx 57510","code_information":[{"code":"7701441","type":"CDM"},{"code":"57510","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.11,"discounted_cash":92.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":232.11,"discounted_cash":92.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Diaphragm Fitting 57170","code_information":[{"code":"7701442","type":"CDM"},{"code":"57170","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.95,"discounted_cash":39.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":97.95,"discounted_cash":39.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Destruction Of Vag Lesion(S), Simple 57061","code_information":[{"code":"7701444","type":"CDM"},{"code":"510","type":"RC"},{"code":"57061","type":"HCPCS"}],"standard_charges":[{"gross_charge":5589.0,"discounted_cash":2235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":3353.4,"discounted_cash":1341.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":2236.0,"discounted_cash":894.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":196.48,"discounted_cash":78.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Benign Lesion Trunk, Arm, Leg Less Than 0.5 Cms 11400","code_information":[{"code":"7701445","type":"CDM"},{"code":"510","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":838.35,"discounted_cash":335.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Benign Lesion Trunk, Arm, Leg 0.6-1.0 Cms 11401","code_information":[{"code":"7701446","type":"CDM"},{"code":"510","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.42,"discounted_cash":312.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":468.86,"discounted_cash":187.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":313.0,"discounted_cash":125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":781.42,"discounted_cash":312.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Benign Lesion Scalp, Neck, Hands, Feet, Gen 0.6-1.0 Cms 11421","code_information":[{"code":"7701447","type":"CDM"},{"code":"510","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.25,"discounted_cash":558.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":838.35,"discounted_cash":335.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":31.05,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Exc Benign Lesion Scalp, Neck, Hands, Feet, Gen 1.1-2.0 Cms 11422","code_information":[{"code":"7701448","type":"CDM"},{"code":"510","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":3260.25,"discounted_cash":1304.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":1956.15,"discounted_cash":782.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":1304.0,"discounted_cash":521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":39.33,"discounted_cash":15.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Hemoglobin Poc","code_information":[{"code":"7704439","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":64.0,"discounted_cash":25.6,"setting":"both","modifiers":"QW","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"Inpatient Hemodialysis","code_information":[{"code":"7705035","type":"CDM"},{"code":"801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inptatient Peritoneal (Non Capd) P/Day","code_information":[{"code":"7705141","type":"CDM"},{"code":"802","type":"RC"}],"standard_charges":[{"gross_charge":1637.0,"discounted_cash":654.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pulm Function Test By Gas 94727","code_information":[{"code":"7705187","type":"CDM"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.14,"discounted_cash":32.86,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"},{"gross_charge":25.17,"discounted_cash":10.07,"setting":"both","modifiers":"26","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"91-120 Min - Rec Rm > Delivery","code_information":[{"code":"7705188","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":353.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"61-90 Min - Rec Rm > Delivery","code_information":[{"code":"7705189","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":393.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"31-60 Min - Rec Rm > Delivery","code_information":[{"code":"7705190","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":751.0,"discounted_cash":300.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"30 Min - Rec Rm > Delivery","code_information":[{"code":"7705191","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"181-210 Min - Rec Rm > Delivery","code_information":[{"code":"7705192","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1641.0,"discounted_cash":656.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"151-180 Min - Rec Rm > Delivery","code_information":[{"code":"7705193","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":578.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"121-150 Min - Rec Rm > Delivery","code_information":[{"code":"7705194","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":496.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Spine Thoracolumbar 2 Views","code_information":[{"code":"7705637","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"},{"gross_charge":37.05,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Myelin Antibody Igg, Ifa-(4639)","code_information":[{"code":"7705877","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":".Advantus Urine Microscopic","code_information":[{"code":"7705883","type":"CDM"},{"code":"300","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt E-Stim In Add To Group Therapy Units","code_information":[{"code":"7706369","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Mech Tract In Add Group Tx Units","code_information":[{"code":"7706370","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","modifiers":"GP|59","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier 59: Distinct Procedural Service"}]},{"description":"Pt Nm Re-Ed Add Group Therapy Units","code_information":[{"code":"7706371","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Home Program 15Min Units","code_information":[{"code":"7706372","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Con Pass Mot Dly Tx-15Min Units","code_information":[{"code":"7706373","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Combo Es/Us-Ea 15Min Units","code_information":[{"code":"7706374","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ot Manual Tx Tech Per 15Min Units","code_information":[{"code":"7706375","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Soft Tissue Mob Ea 15Min Units","code_information":[{"code":"7706376","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Excsn Nail Part/Comp Perm Remo","code_information":[{"code":"7706378","type":"CDM"},{"code":"761","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.0,"discounted_cash":558.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Non Invasive Study Arterie 1-2","code_information":[{"code":"7706380","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":170.4,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Mnt Re-Assess And F/U Ea 15","code_information":[{"code":"7706383","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Op Tx/Pro/Dx Ivp-1St Drug","code_information":[{"code":"7706386","type":"CDM"},{"code":"761","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Impacted Cerumen","code_information":[{"code":"7706390","type":"CDM"},{"code":"761","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rt Charge Vital Capacity","code_information":[{"code":"7706392","type":"CDM"},{"code":"460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 5 - New Patient","code_information":[{"code":"7706401","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 2 - Est Patient","code_information":[{"code":"7706402","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 4 - Est Patient","code_information":[{"code":"7706403","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":192.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pulm Reh; Group; Inc Resp Func Units","code_information":[{"code":"7706404","type":"CDM"},{"code":"948","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Orthotics Fitting - Per 15 Min Units","code_information":[{"code":"7706407","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":66.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Whirlpool In Add Group Tx Units","code_information":[{"code":"7706408","type":"CDM"},{"code":"420","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","modifiers":"GP|59","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier 59: Distinct Procedural Service"}]},{"description":"Pt Ther Ex In Add Group Tx -15 Min Units","code_information":[{"code":"7706409","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ot Whirlpool In Add Group Therapy Units","code_information":[{"code":"7706410","type":"CDM"},{"code":"430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":104.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Selec Wound Debride >20Sqcm Units","code_information":[{"code":"7706411","type":"CDM"},{"code":"430","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Selec Wound Debride <= 20Sqcm Units","code_information":[{"code":"7706412","type":"CDM"},{"code":"430","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot E-Stim Unatt W/Ulcer-Mcr Only Units","code_information":[{"code":"7706413","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0281","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Non Invasive Study Arteries <3","code_information":[{"code":"7706415","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Split Thickness Skin Graft","code_information":[{"code":"7706416","type":"CDM"},{"code":"761","type":"RC"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":8159.0,"discounted_cash":3263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mnt 2Nd Ref Init And F/U Ea 15","code_information":[{"code":"7706417","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dsmt Init 30Min 2-4 Pts","code_information":[{"code":"7706418","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dsmt Ea Add 30Min 2-4 Pts","code_information":[{"code":"7706420","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Infuse Hydrate;Ea Addl Hr","code_information":[{"code":"7706421","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chemo Ivp; Each Addl Substance","code_information":[{"code":"7706424","type":"CDM"},{"code":"331","type":"RC"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 5 - Est Patient","code_information":[{"code":"7706425","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":234.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Selective Debridement >20Sqcm Units","code_information":[{"code":"7706431","type":"CDM"},{"code":"420","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ot Functional Training Ea 15Min Units","code_information":[{"code":"7706434","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Wound Debride Whrpl > 20Sqcm Units","code_information":[{"code":"7706435","type":"CDM"},{"code":"430","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":207.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"App Rigid Ttl Contact Leg Cast","code_information":[{"code":"7706437","type":"CDM"},{"code":"761","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Unna Boot","code_information":[{"code":"7706440","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Avulsion 1 Nail Plate Par/Comp","code_information":[{"code":"7706441","type":"CDM"},{"code":"761","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Symptomat Smoking/Tob 3-10Min","code_information":[{"code":"7706444","type":"CDM"},{"code":"942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dsmt Ea Add 30Min Ind","code_information":[{"code":"7706445","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Therapy Up To 1 Hr","code_information":[{"code":"7706446","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 4 - New Patient","code_information":[{"code":"7706451","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pr Phase 3 Enrollment Fee Units","code_information":[{"code":"7706453","type":"CDM"},{"code":"999","type":"RC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":60.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cr Phase Iii Enrollment Fee Units","code_information":[{"code":"7706454","type":"CDM"},{"code":"999","type":"RC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removecerumen By Lavage Unila","code_information":[{"code":"7706456","type":"CDM"},{"code":"761","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rmval Devit Tissue From Wound","code_information":[{"code":"7706457","type":"CDM"},{"code":"761","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rt Charge Continue Nebulizer Addl Hr","code_information":[{"code":"7706467","type":"CDM"},{"code":"410","type":"RC"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rt Charge Carbon Monux. Quant","code_information":[{"code":"7706475","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":22.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Intermit Comp Add Group Therapy Units","code_information":[{"code":"7706479","type":"CDM"},{"code":"420","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","modifiers":"GP|59","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier 59: Distinct Procedural Service"}]},{"description":"Pt Isokinetic Eval 15 Min Units","code_information":[{"code":"7706480","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Selec Debride W/Whrpl <=20Sqcm Units","code_information":[{"code":"7706481","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Selec Debride W/Whrpl >20Sqcm Units","code_information":[{"code":"7706482","type":"CDM"},{"code":"420","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":207.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Joint Mobilization-Ea 15Min Units","code_information":[{"code":"7706484","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Slp Therapeutic Exercises Ea 15Min Units","code_information":[{"code":"7706485","type":"CDM"},{"code":"440","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Application Bilatral Unna Boot","code_information":[{"code":"7706486","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.0,"discounted_cash":408.4,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Avulsion Nail Plate Ea Add Nai","code_information":[{"code":"7706487","type":"CDM"},{"code":"761","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Limited Study Arteries <3","code_information":[{"code":"7706488","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Therapprophdiagns Inj Sq/Im","code_information":[{"code":"7706490","type":"CDM"},{"code":"761","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Symptomat Smoking/Tob >10Min","code_information":[{"code":"7706492","type":"CDM"},{"code":"942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 1 - Est Patient","code_information":[{"code":"7706494","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pr Phase 3 Monthly - Op Units","code_information":[{"code":"7706497","type":"CDM"},{"code":"999","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cr Phase Iii Monthly - Op Units","code_information":[{"code":"7706498","type":"CDM"},{"code":"999","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Man Tx Ad Grp-15Min Units","code_information":[{"code":"7706501","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","modifiers":"GP|59","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier 59: Distinct Procedural Service"}]},{"description":"Pt Intermittent Compress Units","code_information":[{"code":"7706502","type":"CDM"},{"code":"420","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Nonselective Debridement Units","code_information":[{"code":"7706503","type":"CDM"},{"code":"420","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":209.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ot Phonophoresis Per 15Min Units","code_information":[{"code":"7706506","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":63.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Nonselective Debridement Units","code_information":[{"code":"7706507","type":"CDM"},{"code":"430","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":209.2,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Slp Swallow Eval W Radio-Opaque Units","code_information":[{"code":"7706508","type":"CDM"},{"code":"444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":124.4,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"App Multi-Layer Comp System Bk","code_information":[{"code":"7706509","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bil App Multi-Layer Comp Sys Bk","code_information":[{"code":"7706510","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":372.8,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Biopsy Bone Open Superficial","code_information":[{"code":"7706511","type":"CDM"},{"code":"761","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6725.0,"discounted_cash":2690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debridement Each Add 20Sqcm","code_information":[{"code":"7706512","type":"CDM"},{"code":"761","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Debridement Open 1St 20Sqcm","code_information":[{"code":"7706513","type":"CDM"},{"code":"761","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rt Charge Continue Nebulizer","code_information":[{"code":"7706517","type":"CDM"},{"code":"410","type":"RC"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dsmt Init","code_information":[{"code":"7706524","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dsmt Ea 30Min 5-8 Pts","code_information":[{"code":"7706525","type":"CDM"},{"code":"942","type":"RC"},{"code":"98962","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ea Addl Ivp Same Subst >30Min","code_information":[{"code":"7706530","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 2 - New Patient","code_information":[{"code":"7706532","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 3 - New Patient","code_information":[{"code":"7706533","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Split-Thickness Autograft","code_information":[{"code":"7706541","type":"CDM"},{"code":"761","type":"RC"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":9757.0,"discounted_cash":3902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pt Iont In Add Group Therapy Units","code_information":[{"code":"7706559","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Pt Gait Train Ad To Grp-Ea 15Min Units","code_information":[{"code":"7706560","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","modifiers":"GP|59","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier 59: Distinct Procedural Service"}]},{"description":"Pt Selective Debridement <=20Sqcm Units","code_information":[{"code":"7706561","type":"CDM"},{"code":"420","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Ot E-Stim In Add To Group Therapy Units","code_information":[{"code":"7706562","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Ot Wound Debride Whrpl <= 20Sqcm Units","code_information":[{"code":"7706563","type":"CDM"},{"code":"430","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Slp Nasophary W/Endoscopy Units","code_information":[{"code":"7706564","type":"CDM"},{"code":"471","type":"RC"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Biopsy Bone Trocar/Needle Supe","code_information":[{"code":"7706565","type":"CDM"},{"code":"761","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":1336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mnt Initial Assessment Per 15","code_information":[{"code":"7706568","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mnt Group-Each 30Min","code_information":[{"code":"7706569","type":"CDM"},{"code":"942","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dsmt Ea Add 30Min 5-8 Pts","code_information":[{"code":"7706570","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iv Therapy Each Addl Hr","code_information":[{"code":"7706571","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Level 3 - Est Patient","code_information":[{"code":"7706574","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pulm Reh; Strength/Endur 15Min Units","code_information":[{"code":"7706575","type":"CDM"},{"code":"948","type":"RC"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Perma-Hand 2-0 18In 3/8 Circ Fs Revers Cut Black 1 Strand/Pk 685G Uni-Direct Wax Coat","code_information":[{"code":"7706767","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Room/Bed: Nursery Level 2","code_information":[{"code":"7707448","type":"CDM"},{"code":"172","type":"RC"}],"standard_charges":[{"gross_charge":2042.0,"discounted_cash":816.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Nursery Level 3","code_information":[{"code":"7707449","type":"CDM"},{"code":"173","type":"RC"}],"standard_charges":[{"gross_charge":3513.0,"discounted_cash":1405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Medical","code_information":[{"code":"7707450","type":"CDM"},{"code":"110","type":"RC"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Surgical","code_information":[{"code":"7707451","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":2143.0,"discounted_cash":857.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Room/Bed: Telemetry","code_information":[{"code":"7707455","type":"CDM"},{"code":"119","type":"RC"}],"standard_charges":[{"gross_charge":2222.0,"discounted_cash":888.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tiva","code_information":[{"code":"7711353","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":21.64,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Deep Sedation","code_information":[{"code":"7711354","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Gram Stain Add-On","code_information":[{"code":"7711957","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"C Difficle Ag Add-On","code_information":[{"code":"7711958","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Viral Influenze Grp B Add-On","code_information":[{"code":"7711959","type":"CDM"},{"code":"306","type":"RC"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tissue Grinding","code_information":[{"code":"7711997","type":"CDM"},{"code":"300","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Additional Id (Bld)","code_information":[{"code":"7711998","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Gpi/Path (Bld)","code_information":[{"code":"7711999","type":"CDM"},{"code":"300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Campy Workup","code_information":[{"code":"7712001","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Additional Id (Ur)","code_information":[{"code":"7712002","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Additional Id (N-Ur)","code_information":[{"code":"7712003","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Gpi/Path/Sta (N-Ur)","code_information":[{"code":"7712004","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Gpi/Path/Sta (Ur)","code_information":[{"code":"7712005","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Kit Staph (Bld)","code_information":[{"code":"7712006","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Kit Staph (Ur)","code_information":[{"code":"7712007","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Organism Id By Kit Staph (N-Ur)","code_information":[{"code":"7712008","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Id Gram Negataive Ast Gn80","code_information":[{"code":"7712009","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Id Gram Positive Vgp St01","code_information":[{"code":"7712010","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Id Gram Positive Ast Gp75","code_information":[{"code":"7712011","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pinworm Prep","code_information":[{"code":"7712012","type":"CDM"},{"code":"300","type":"RC"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bed Bug Id","code_information":[{"code":"7712015","type":"CDM"},{"code":"300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"India Ink Prep","code_information":[{"code":"7712016","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kirby Bauer Gnb Cipro","code_information":[{"code":"7712023","type":"CDM"},{"code":"300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gram Negative Sensitivity Panel(Vitek 80)","code_information":[{"code":"7712026","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gram Positive Sensitivity Panel Strep (Vitek 02)","code_information":[{"code":"7712046","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gram Positive Sensitivity Panel (Vitek 75)","code_information":[{"code":"7712078","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adult Wellness, Subseq Visit G0439","code_information":[{"code":"7714280","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":155.25,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Adult Wellness, Initial Visit G0438","code_information":[{"code":"7714281","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0438","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":93.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Welcome To Medicare Ippe G0402","code_information":[{"code":"7714282","type":"CDM"},{"code":"521","type":"RC"},{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":165.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":110.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":248.4,"discounted_cash":99.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Ir Angiogram Renal Unilateral","code_information":[{"code":"7714290","type":"CDM"},{"code":"323","type":"RC"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.0,"discounted_cash":4566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Angio Abdomen Aorta + Runoff","code_information":[{"code":"7714294","type":"CDM"},{"code":"352","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2673.0,"discounted_cash":1069.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nm Kidney Imaging Single W/O Pharm","code_information":[{"code":"7714305","type":"CDM"},{"code":"341","type":"RC"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":1161.0,"discounted_cash":464.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Us Pelvis Complete","code_information":[{"code":"7714307","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1306.0,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Xr Wrist Arthography","code_information":[{"code":"7714313","type":"CDM"},{"code":"320","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ct Aspiration/Inject Renal Cyst/Pelvis","code_information":[{"code":"7714443","type":"CDM"},{"code":"350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body From Throat","code_information":[{"code":"7716133","type":"CDM"},{"code":"450","type":"RC"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Of (2.5 Centimeter Or Less) Mouth Laceratio","code_information":[{"code":"7716134","type":"CDM"},{"code":"450","type":"RC"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":373.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Vertical Lip Wound Extending To Over Hal","code_information":[{"code":"7716135","type":"CDM"},{"code":"450","type":"RC"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":2354.0,"discounted_cash":941.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Embedded Foreign Body From Soft Tissue","code_information":[{"code":"7716136","type":"CDM"},{"code":"450","type":"RC"},{"code":"41805","type":"HCPCS"}],"standard_charges":[{"gross_charge":7702.0,"discounted_cash":3080.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Embedded Foreign Body Of Mouth","code_information":[{"code":"7716137","type":"CDM"},{"code":"450","type":"RC"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":2234.0,"discounted_cash":893.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of (Over 2.6 Laceration) To Floor Of Mouth","code_information":[{"code":"7716138","type":"CDM"},{"code":"450","type":"RC"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2707.0,"discounted_cash":1082.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of (2.5 Centimeter Or Less) Laceration To F","code_information":[{"code":"7716139","type":"CDM"},{"code":"450","type":"RC"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Of (Over 2.5 Centimeter) Mouth Laceration","code_information":[{"code":"7716140","type":"CDM"},{"code":"450","type":"RC"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1946.0,"discounted_cash":778.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Lip And Border","code_information":[{"code":"7716141","type":"CDM"},{"code":"450","type":"RC"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2302.0,"discounted_cash":920.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mouth Procedure","code_information":[{"code":"7716142","type":"CDM"},{"code":"450","type":"RC"},{"code":"42299","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":337.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Relocation Of Mouth Tissue To Gum Surface","code_information":[{"code":"7716143","type":"CDM"},{"code":"450","type":"RC"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":337.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Aspiration Of Bladder","code_information":[{"code":"7716145","type":"CDM"},{"code":"450","type":"RC"},{"code":"51100","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bladder Irrigation And/Or Instillation","code_information":[{"code":"7716146","type":"CDM"},{"code":"450","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Suture Around Skin Surface Tube With Ch","code_information":[{"code":"7716147","type":"CDM"},{"code":"450","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":704.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Skin Suture With Change Of Bladder Tube","code_information":[{"code":"7716148","type":"CDM"},{"code":"450","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilation Of Narrowing Of Bladder Canal (Urethra),","code_information":[{"code":"7716149","type":"CDM"},{"code":"450","type":"RC"},{"code":"53620","type":"HCPCS"}],"standard_charges":[{"gross_charge":5337.0,"discounted_cash":2134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Abscess Or Cyst Of Skene's Glands, Mal","code_information":[{"code":"7716151","type":"CDM"},{"code":"450","type":"RC"},{"code":"53060","type":"HCPCS"}],"standard_charges":[{"gross_charge":5396.0,"discounted_cash":2158.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Material From Skin, Tissue, Mus","code_information":[{"code":"7716152","type":"CDM"},{"code":"450","type":"RC"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":695.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Material From Skin And Tissue A","code_information":[{"code":"7716153","type":"CDM"},{"code":"450","type":"RC"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Skin And Bone First 20 Sq Cm Or Less","code_information":[{"code":"7716154","type":"CDM"},{"code":"450","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3441.0,"discounted_cash":1376.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Skin And/Or Muscle First 20 Sq Cm Or Le","code_information":[{"code":"7716155","type":"CDM"},{"code":"450","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.0,"discounted_cash":626.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Skin And Tissue First 20 Sq Cm Or Less","code_information":[{"code":"7716156","type":"CDM"},{"code":"450","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Inflamed Or Infected Skin, Up To 10% Of","code_information":[{"code":"7716157","type":"CDM"},{"code":"450","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Destruction Of Skin Growth (Less Than 10 Sq Centim","code_information":[{"code":"7716158","type":"CDM"},{"code":"450","type":"RC"},{"code":"17106","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.0,"discounted_cash":335.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Change And/Or Removal Of Burn Tissue (5%","code_information":[{"code":"7716159","type":"CDM"},{"code":"450","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Change And/Or Removal Of Burn Tissue (Gre","code_information":[{"code":"7716160","type":"CDM"},{"code":"450","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Change And/Or Removal Of Burn Tissue (Les","code_information":[{"code":"7716161","type":"CDM"},{"code":"450","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Blood Accumulation Between Nail And Nai","code_information":[{"code":"7716162","type":"CDM"},{"code":"450","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Growth (0.6 To 1.0 Centimeters) Of The","code_information":[{"code":"7716163","type":"CDM"},{"code":"450","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2113.0,"discounted_cash":845.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exc Face-Mm  1.1-2 Cm<","code_information":[{"code":"7716164","type":"CDM"},{"code":"450","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":2113.0,"discounted_cash":845.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exc Face-Mm  0.5 Cm<","code_information":[{"code":"7716165","type":"CDM"},{"code":"450","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":484.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Growth (Over 4.0 Centimeters) Of The Sc","code_information":[{"code":"7716166","type":"CDM"},{"code":"450","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":6108.0,"discounted_cash":2443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exc H-F-Nk-Sp  1.1-2Cm","code_information":[{"code":"7716167","type":"CDM"},{"code":"450","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":2603.0,"discounted_cash":1041.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exc H-F-Nk-Sp  0.5 Cm<","code_information":[{"code":"7716168","type":"CDM"},{"code":"450","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.0,"discounted_cash":887.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exc Tr-Ext 0.5Cm<","code_information":[{"code":"7716169","type":"CDM"},{"code":"450","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Growth (2.1 To 3.0 Centimeters) Of The","code_information":[{"code":"7716170","type":"CDM"},{"code":"450","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.0,"discounted_cash":1013.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Nail","code_information":[{"code":"7716171","type":"CDM"},{"code":"450","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1439.0,"discounted_cash":575.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Skin Of Finger Or Toe Nail","code_information":[{"code":"7716172","type":"CDM"},{"code":"450","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":209.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Nail With Amputation Of Fingertip","code_information":[{"code":"7716173","type":"CDM"},{"code":"450","type":"RC"},{"code":"26236","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fine Needle Aspiration With Imaging Guidance","code_information":[{"code":"7716174","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":2046.0,"discounted_cash":818.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Episiotomy Or Vaginal Repair","code_information":[{"code":"7716175","type":"CDM"},{"code":"450","type":"RC"},{"code":"59300","type":"HCPCS"}],"standard_charges":[{"gross_charge":5330.0,"discounted_cash":2132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repositioning Of Foreskin Including Scar Tissue Re","code_information":[{"code":"7716176","type":"CDM"},{"code":"450","type":"RC"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision Of Membrane At Uterine Opening","code_information":[{"code":"7716177","type":"CDM"},{"code":"450","type":"RC"},{"code":"56442","type":"HCPCS"}],"standard_charges":[{"gross_charge":5047.0,"discounted_cash":2018.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injection Procedure To Induce Erection","code_information":[{"code":"7716180","type":"CDM"},{"code":"450","type":"RC"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Non-Indwelling Bladder Catheter","code_information":[{"code":"7716181","type":"CDM"},{"code":"450","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injection Of Drug Into Erectile Tissue At Sides An","code_information":[{"code":"7716182","type":"CDM"},{"code":"450","type":"RC"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ultrasound Measurement Of Bladder Capacity After V","code_information":[{"code":"7716183","type":"CDM"},{"code":"920","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Drainage Of Female Genitals Abscess","code_information":[{"code":"7716184","type":"CDM"},{"code":"450","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Twisted Testicle","code_information":[{"code":"7716185","type":"CDM"},{"code":"450","type":"RC"},{"code":"54600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":927.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Intra-Uterine Device (Iud) For Pregnanc","code_information":[{"code":"7716186","type":"CDM"},{"code":"450","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":132.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Temporary Bladder Catheter","code_information":[{"code":"7716188","type":"CDM"},{"code":"450","type":"RC"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Excisional Destruction Of Penile Growths","code_information":[{"code":"7716189","type":"CDM"},{"code":"450","type":"RC"},{"code":"54060","type":"HCPCS"}],"standard_charges":[{"gross_charge":2027.0,"discounted_cash":810.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision Of Corner Of Eye At Eyelids","code_information":[{"code":"7716191","type":"CDM"},{"code":"450","type":"RC"},{"code":"67715","type":"HCPCS"}],"standard_charges":[{"gross_charge":4967.0,"discounted_cash":1986.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Skin Abscess Simple","code_information":[{"code":"7716193","type":"CDM"},{"code":"450","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Skin Abscess Complex","code_information":[{"code":"7716194","type":"CDM"},{"code":"450","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Drainage Of Hematoma Seroma Or Fluid","code_information":[{"code":"7716195","type":"CDM"},{"code":"450","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3964.0,"discounted_cash":1585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Drainage Of Pilonidal Cyst Simple","code_information":[{"code":"7716196","type":"CDM"},{"code":"450","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Removal Of Foreign Body Subcutaneous","code_information":[{"code":"7716198","type":"CDM"},{"code":"450","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"First Degree Burn Treatment","code_information":[{"code":"7716199","type":"CDM"},{"code":"450","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":94.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Breast Abscess","code_information":[{"code":"7716200","type":"CDM"},{"code":"450","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":4949.0,"discounted_cash":1979.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Finger Or Toe Nail Bed With Graft","code_information":[{"code":"7716201","type":"CDM"},{"code":"450","type":"RC"},{"code":"11762","type":"HCPCS"}],"standard_charges":[{"gross_charge":5138.0,"discounted_cash":2055.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Up To And Including 15 Skin Tags","code_information":[{"code":"7716202","type":"CDM"},{"code":"450","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Finger Or Toe Nail Bed","code_information":[{"code":"7716203","type":"CDM"},{"code":"450","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (Over 30.0 Centimeters) Of The Sca","code_information":[{"code":"7716204","type":"CDM"},{"code":"450","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (1.1 To 2.5 Centimeters) Of Eyelid","code_information":[{"code":"7716205","type":"CDM"},{"code":"450","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.6 To 7.5 Centimeters) Of Eyelid","code_information":[{"code":"7716206","type":"CDM"},{"code":"450","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (1.1 To 2.5 Centimeters) Of Forehe","code_information":[{"code":"7716207","type":"CDM"},{"code":"450","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.6 To 7.5 Centimeters) Of Forehe","code_information":[{"code":"7716208","type":"CDM"},{"code":"450","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (1.1 To 2.5 Centimeters) Of Scalp,","code_information":[{"code":"7716209","type":"CDM"},{"code":"450","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.6 To 7.5 Centimeters) Of Scalp,","code_information":[{"code":"7716210","type":"CDM"},{"code":"450","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (1.1 To 2.5 Centimeters) Of Trunk","code_information":[{"code":"7716211","type":"CDM"},{"code":"450","type":"RC"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1615.0,"discounted_cash":646.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.5 Centimeters Or Less) Of Neck,","code_information":[{"code":"7716212","type":"CDM"},{"code":"450","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":171.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (Over 30.0 Centimeters) Of Neck, H","code_information":[{"code":"7716213","type":"CDM"},{"code":"450","type":"RC"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (12.6 To 20.0 Centimeters) Of Neck","code_information":[{"code":"7716214","type":"CDM"},{"code":"450","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.6 To 7.5 Centimeters) Of Neck,","code_information":[{"code":"7716215","type":"CDM"},{"code":"450","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (20.1 To 30.0 Centimeters) Of Neck","code_information":[{"code":"7716216","type":"CDM"},{"code":"450","type":"RC"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (7.6 To 12.5 Centimeters) Of Neck,","code_information":[{"code":"7716217","type":"CDM"},{"code":"450","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound Of Forehead, Cheeks, Chin, Mouth,","code_information":[{"code":"7716218","type":"CDM"},{"code":"450","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound Of Scalp, Arms, And/Or Legs","code_information":[{"code":"7716219","type":"CDM"},{"code":"450","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.6 To 7.5 Centimeters) Of Trunk","code_information":[{"code":"7716220","type":"CDM"},{"code":"450","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":674.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound Of Trunk","code_information":[{"code":"7716221","type":"CDM"},{"code":"450","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.5 Centimeters Or Less) Of Face,","code_information":[{"code":"7716222","type":"CDM"},{"code":"450","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (12.6 To 20.0 Centimeters) Of Face","code_information":[{"code":"7716223","type":"CDM"},{"code":"450","type":"RC"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.6 To 5.0 Centimeters) Of Face,","code_information":[{"code":"7716224","type":"CDM"},{"code":"450","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (20.1 To 30.0 Centimeters) Of Face","code_information":[{"code":"7716225","type":"CDM"},{"code":"450","type":"RC"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (5.1 To 7.5 Centimeters) Of Face,","code_information":[{"code":"7716226","type":"CDM"},{"code":"450","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (7.6 To 12.5 Centimeters) Of Face,","code_information":[{"code":"7716227","type":"CDM"},{"code":"450","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":241.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rpr Wnd 2.6-7.5Cm Sclp;Undrarm;Trnk;Arm;Lgs","code_information":[{"code":"7716228","type":"CDM"},{"code":"450","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rpr Wnd 20.1-30Cm Sclp;Undrarm;Trnk;Arm;Lgs","code_information":[{"code":"7716229","type":"CDM"},{"code":"450","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rpr Wnd 7.6-12.5Cm Sclp;Undrarm;Trnk;Arm;Lgs","code_information":[{"code":"7716230","type":"CDM"},{"code":"450","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.5 Centimeters Or Less) Of The F","code_information":[{"code":"7716231","type":"CDM"},{"code":"450","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (2.6 To 5.0 Centimeters) Of The Fa","code_information":[{"code":"7716232","type":"CDM"},{"code":"450","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (Over 30.0 Centimeters) Of The Fac","code_information":[{"code":"7716233","type":"CDM"},{"code":"450","type":"RC"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rpr Wnd 12.6-20Cm Any Face;Ears;Mouth","code_information":[{"code":"7716234","type":"CDM"},{"code":"450","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rpr Wnd 20.1-30Cm Any Face;Ears;Mouth","code_information":[{"code":"7716235","type":"CDM"},{"code":"450","type":"RC"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (5.1 To 7.5 Centimeters) Of The Fa","code_information":[{"code":"7716236","type":"CDM"},{"code":"450","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Wound (7.6 To 12.5 Centimeters) Of The F","code_information":[{"code":"7716237","type":"CDM"},{"code":"450","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rpr Wnd 2.5<Cm Sclp;Undrarm;Trnk;Arm;Lgs","code_information":[{"code":"7716238","type":"CDM"},{"code":"450","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rpr Wnd 12.6-20Cm Sclp;Undrarm;Trnk;Geitl;Arm;Lgs","code_information":[{"code":"7716239","type":"CDM"},{"code":"450","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shave Skin Lesion 0.5 Cm<Trk:Lgs:Arm","code_information":[{"code":"7716240","type":"CDM"},{"code":"450","type":"RC"},{"code":"11300","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shave Skin Lesion 0.5 Cm<Any Face;Ears;Mouth","code_information":[{"code":"7716241","type":"CDM"},{"code":"450","type":"RC"},{"code":"11310","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shave Skin Lesion 0.5 Sclp;Nck;Hnd;Ft;Genitl","code_information":[{"code":"7716242","type":"CDM"},{"code":"450","type":"RC"},{"code":"11305","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trimming Of Fingernails Or Toenails","code_information":[{"code":"7716243","type":"CDM"},{"code":"450","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Separation Of Wound Closure","code_information":[{"code":"7716244","type":"CDM"},{"code":"450","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":191.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Amputation Of Finger Or Thumb","code_information":[{"code":"7716245","type":"CDM"},{"code":"450","type":"RC"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":5258.0,"discounted_cash":2103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strapping Of Ankle And/Or Foot","code_information":[{"code":"7716246","type":"CDM"},{"code":"450","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Moveable, Hinged Finger Splint","code_information":[{"code":"7716247","type":"CDM"},{"code":"450","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Long Arm Splint (Shoulder To Hand)","code_information":[{"code":"7716248","type":"CDM"},{"code":"450","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":174.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Non-Moveable, Hinged Finger Splint","code_information":[{"code":"7716249","type":"CDM"},{"code":"450","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Short Leg Cast (Below Knee To Toes)","code_information":[{"code":"7716250","type":"CDM"},{"code":"450","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":303.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspiration And/Or Injection Of Small Joint Or Join","code_information":[{"code":"7716251","type":"CDM"},{"code":"450","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspiration And/Or Injection Of Large Joint Or Join","code_information":[{"code":"7716252","type":"CDM"},{"code":"450","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":387.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspiration And/Or Injection Of Medium Joint Or Joi","code_information":[{"code":"7716253","type":"CDM"},{"code":"450","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":347.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Forearm Bone With Manip","code_information":[{"code":"7716254","type":"CDM"},{"code":"450","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":593.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Ankle","code_information":[{"code":"7716255","type":"CDM"},{"code":"450","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Forearm Bone Of Elb","code_information":[{"code":"7716256","type":"CDM"},{"code":"450","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Collar Bone Fracture","code_information":[{"code":"7716257","type":"CDM"},{"code":"450","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Thigh Bone With Manipul","code_information":[{"code":"7716258","type":"CDM"},{"code":"450","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":6273.0,"discounted_cash":2509.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Treatment Of Elbow Dislocation","code_information":[{"code":"7716259","type":"CDM"},{"code":"450","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Treatment Of Hip Dislocation","code_information":[{"code":"7716260","type":"CDM"},{"code":"450","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Thumb Dislocation With Manipul","code_information":[{"code":"7716262","type":"CDM"},{"code":"450","type":"RC"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Fracture Hand Bone","code_information":[{"code":"7716265","type":"CDM"},{"code":"450","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":174.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Toe","code_information":[{"code":"7716266","type":"CDM"},{"code":"450","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Jaw Temporomandibular Joint (T","code_information":[{"code":"7716267","type":"CDM"},{"code":"450","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Hip Socket Fractures With Mani","code_information":[{"code":"7716268","type":"CDM"},{"code":"450","type":"RC"},{"code":"27222","type":"HCPCS"}],"standard_charges":[{"gross_charge":6288.0,"discounted_cash":2515.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Treat Grwth Plt;Uparm At Elbw","code_information":[{"code":"7716269","type":"CDM"},{"code":"450","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Forearm Bone At Elbow W","code_information":[{"code":"7716270","type":"CDM"},{"code":"450","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":200.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocation Of Knee Cap","code_information":[{"code":"7716272","type":"CDM"},{"code":"450","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Foot Bone","code_information":[{"code":"7716273","type":"CDM"},{"code":"450","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Forearm At Wrist Bone","code_information":[{"code":"7716274","type":"CDM"},{"code":"450","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Tailbone","code_information":[{"code":"7716275","type":"CDM"},{"code":"450","type":"RC"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Fracture Of Lower Weight Beari","code_information":[{"code":"7716276","type":"CDM"},{"code":"450","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":4935.0,"discounted_cash":1974.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Knee Dislocation","code_information":[{"code":"7716277","type":"CDM"},{"code":"450","type":"RC"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Hand Joint With Man","code_information":[{"code":"7716278","type":"CDM"},{"code":"450","type":"RC"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Shoulder Dislocation And Broke","code_information":[{"code":"7716279","type":"CDM"},{"code":"450","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2605.0,"discounted_cash":1042.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Treat Shlder Dislocation W Manip W Anes","code_information":[{"code":"7716280","type":"CDM"},{"code":"450","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1416.0,"discounted_cash":566.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Forearm Bones","code_information":[{"code":"7716281","type":"CDM"},{"code":"450","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Treat Fngr Jt Dislocation W Manip","code_information":[{"code":"7716282","type":"CDM"},{"code":"450","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Knee Cap Dislocation Under Ane","code_information":[{"code":"7716283","type":"CDM"},{"code":"450","type":"RC"},{"code":"27562","type":"HCPCS"}],"standard_charges":[{"gross_charge":2588.0,"discounted_cash":1035.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Or Growth Plate Separat","code_information":[{"code":"7716284","type":"CDM"},{"code":"450","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":4003.0,"discounted_cash":1601.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Of Upper Arm Bone At Sh","code_information":[{"code":"7716285","type":"CDM"},{"code":"450","type":"RC"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":593.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Hand Bone Under Ane","code_information":[{"code":"7716286","type":"CDM"},{"code":"450","type":"RC"},{"code":"26675","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":200.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Ankle Dislocation","code_information":[{"code":"7716287","type":"CDM"},{"code":"450","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":593.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hand Or Finger Procedure","code_information":[{"code":"7716288","type":"CDM"},{"code":"450","type":"RC"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Collar Bone And Shoulder Joint","code_information":[{"code":"7716289","type":"CDM"},{"code":"450","type":"RC"},{"code":"23540","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Treat Grwth Plt;Uparm At Elbw W Manip","code_information":[{"code":"7716290","type":"CDM"},{"code":"450","type":"RC"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injection Of Anesthetic Agent, Thigh Nerve","code_information":[{"code":"7716298","type":"CDM"},{"code":"450","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1111.0,"discounted_cash":444.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injection Of Anesthetic Agent, Greater Occipital N","code_information":[{"code":"7716299","type":"CDM"},{"code":"450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injection Of Anesthetic Agent, Other Peripheral Ne","code_information":[{"code":"7716301","type":"CDM"},{"code":"450","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspiration Or Injection Of Cerebrospinal Fluid Shu","code_information":[{"code":"7716302","type":"CDM"},{"code":"450","type":"RC"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":712.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Impact Ear Wax, One Ear","code_information":[{"code":"7716303","type":"CDM"},{"code":"450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Impacted Cerumen Using Irrigationlavage Un","code_information":[{"code":"7716304","type":"CDM"},{"code":"450","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spinal Tap With Drainage Of Spinal Fluid","code_information":[{"code":"7716305","type":"CDM"},{"code":"450","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.0,"discounted_cash":855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injection Into Artery For Therapy, Diagnosis, Or P","code_information":[{"code":"7716306","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken And Dislocated Forearm","code_information":[{"code":"7716307","type":"CDM"},{"code":"450","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":4789.0,"discounted_cash":1915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Toe With Manipulation","code_information":[{"code":"7716308","type":"CDM"},{"code":"450","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Hip Prosthesis Unde","code_information":[{"code":"7716309","type":"CDM"},{"code":"450","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":3456.0,"discounted_cash":1382.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Hip Prosthesis","code_information":[{"code":"7716310","type":"CDM"},{"code":"450","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Upper Arm Bone At Shoul","code_information":[{"code":"7716311","type":"CDM"},{"code":"450","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Upper Arm Bone With Man","code_information":[{"code":"7716312","type":"CDM"},{"code":"450","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Upper Arm Fracture","code_information":[{"code":"7716313","type":"CDM"},{"code":"450","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Wrist Bone With Man","code_information":[{"code":"7716314","type":"CDM"},{"code":"450","type":"RC"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":4789.0,"discounted_cash":1915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Fracture Of Bone Of Hand With","code_information":[{"code":"7716315","type":"CDM"},{"code":"450","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Fracture Of Foot With Manipula","code_information":[{"code":"7716316","type":"CDM"},{"code":"450","type":"RC"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Finger Or Thumb With Ma","code_information":[{"code":"7716317","type":"CDM"},{"code":"450","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Forearm Bones With Mani","code_information":[{"code":"7716318","type":"CDM"},{"code":"450","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Shoulder Blade With Man","code_information":[{"code":"7716319","type":"CDM"},{"code":"450","type":"RC"},{"code":"23575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1546.0,"discounted_cash":618.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Shin Bone With Manipula","code_information":[{"code":"7716320","type":"CDM"},{"code":"450","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":4789.0,"discounted_cash":1915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Great Toe With Manipula","code_information":[{"code":"7716321","type":"CDM"},{"code":"450","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocation Of Toe Joint","code_information":[{"code":"7716322","type":"CDM"},{"code":"450","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Skull And Face Bone Procedure","code_information":[{"code":"7716323","type":"CDM"},{"code":"450","type":"RC"},{"code":"21299","type":"HCPCS"}],"standard_charges":[{"gross_charge":822.0,"discounted_cash":328.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Broken Finger Or Thumb","code_information":[{"code":"7716324","type":"CDM"},{"code":"450","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exploration Of Penetrating Wound Of Arm Or Leg","code_information":[{"code":"7716326","type":"CDM"},{"code":"450","type":"RC"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exploration Of Penetrating Wound Of Chest","code_information":[{"code":"7716327","type":"CDM"},{"code":"450","type":"RC"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":6823.0,"discounted_cash":2729.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Finger Abscess Simple","code_information":[{"code":"7716328","type":"CDM"},{"code":"450","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Fluid-Filled Sac (Bursa) Of Upper Arm","code_information":[{"code":"7716329","type":"CDM"},{"code":"450","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":6545.0,"discounted_cash":2618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injections Of Tendon Sheath, Ligament, Or Muscle M","code_information":[{"code":"7716330","type":"CDM"},{"code":"450","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":387.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Drainage Of Ear Canal Abscess","code_information":[{"code":"7716332","type":"CDM"},{"code":"450","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body From Ear Canal","code_information":[{"code":"7716333","type":"CDM"},{"code":"450","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Drainage Of Eyelid Abscess","code_information":[{"code":"7716336","type":"CDM"},{"code":"450","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injection Of Anesthetic Agent, Trigeminal Nerve","code_information":[{"code":"7716337","type":"CDM"},{"code":"450","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body, External Eye, Cornea With","code_information":[{"code":"7716338","type":"CDM"},{"code":"450","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body, External Eye, Cornea","code_information":[{"code":"7716339","type":"CDM"},{"code":"450","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Embedded Foreign Body In Eyelid","code_information":[{"code":"7716340","type":"CDM"},{"code":"450","type":"RC"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":436.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lumbar Puncture Diagnostic","code_information":[{"code":"7716342","type":"CDM"},{"code":"450","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.0,"discounted_cash":855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Injections Of Trigger Points In 3 Or More Muscles","code_information":[{"code":"7716343","type":"CDM"},{"code":"450","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"discounted_cash":363.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tissue Transfer Repair Of Wound (10.1 To 30.0 Sq C","code_information":[{"code":"7716345","type":"CDM"},{"code":"450","type":"RC"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":6060.0,"discounted_cash":2424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Long Leg Splint (Thigh To Ankle Or","code_information":[{"code":"7716347","type":"CDM"},{"code":"450","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biopsy Of Each Additional Growth Of Skin And/Or Ti","code_information":[{"code":"7716348","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":427.0,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biopsy Of Single Growth Of Skin And/Or Tissue","code_information":[{"code":"7716349","type":"CDM"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Chemical Agent To Excessive Wound T","code_information":[{"code":"7716350","type":"CDM"},{"code":"450","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fine Needle Aspiration Without Imaging Guidance","code_information":[{"code":"7716351","type":"CDM"},{"code":"450","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":413.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Manipulation Of Hinged Joints Of Upper And Lower J","code_information":[{"code":"7716352","type":"CDM"},{"code":"450","type":"RC"},{"code":"21073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2897.0,"discounted_cash":1158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body Of Foot Tissue, Accessed B","code_information":[{"code":"7716354","type":"CDM"},{"code":"450","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":507.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Or Bivalving Of Full Arm Or Leg Cast","code_information":[{"code":"7716355","type":"CDM"},{"code":"450","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body Of Upper Arm Or Elbow Area","code_information":[{"code":"7716356","type":"CDM"},{"code":"450","type":"RC"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.0,"discounted_cash":702.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body In Muscle Or Tendon","code_information":[{"code":"7716358","type":"CDM"},{"code":"450","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":507.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Leg Tendon","code_information":[{"code":"7716359","type":"CDM"},{"code":"450","type":"RC"},{"code":"27658","type":"HCPCS"}],"standard_charges":[{"gross_charge":6064.0,"discounted_cash":2425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Foot Tendon","code_information":[{"code":"7716360","type":"CDM"},{"code":"450","type":"RC"},{"code":"28200","type":"HCPCS"}],"standard_charges":[{"gross_charge":6915.0,"discounted_cash":2766.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Finger Tendon","code_information":[{"code":"7716361","type":"CDM"},{"code":"450","type":"RC"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":5255.0,"discounted_cash":2102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Hand Tendon","code_information":[{"code":"7716362","type":"CDM"},{"code":"450","type":"RC"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":4750.0,"discounted_cash":1900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Non-Moveable, Short Arm Splint (For","code_information":[{"code":"7716363","type":"CDM"},{"code":"450","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":155.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Application Of Short Leg Splint (Calf To Foot)","code_information":[{"code":"7716364","type":"CDM"},{"code":"450","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strapping Of Toes","code_information":[{"code":"7716365","type":"CDM"},{"code":"450","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closed Treatment Of Dislocated Hand Bone With Mani","code_information":[{"code":"7716366","type":"CDM"},{"code":"450","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":168.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Treatment Of Dislocated Elbow Under Anesthesia","code_information":[{"code":"7716367","type":"CDM"},{"code":"450","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2527.0,"discounted_cash":1010.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Leg Or Ankle Procedure","code_information":[{"code":"7716368","type":"CDM"},{"code":"450","type":"RC"},{"code":"27899","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Complex Control Of Nose Bleed","code_information":[{"code":"7716369","type":"CDM"},{"code":"450","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":171.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Simple Control Of Nose Bleed","code_information":[{"code":"7716370","type":"CDM"},{"code":"450","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Control Of Nose Bleed And Insertion Of Packing","code_information":[{"code":"7716371","type":"CDM"},{"code":"450","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Control Of Nosebleed And Insertion Of Packing","code_information":[{"code":"7716372","type":"CDM"},{"code":"450","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Abscess Or Blood Accumulation In Nose","code_information":[{"code":"7716373","type":"CDM"},{"code":"450","type":"RC"},{"code":"30000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body In Nose","code_information":[{"code":"7716374","type":"CDM"},{"code":"450","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Diagnostic Examination Of Voice Box Using An Endos","code_information":[{"code":"7716376","type":"CDM"},{"code":"450","type":"RC"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":4696.0,"discounted_cash":1878.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergent Surgical Opening Of Windpipe For Insertio","code_information":[{"code":"7716377","type":"CDM"},{"code":"450","type":"RC"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.0,"discounted_cash":1132.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergent Insertion Of Breathing Tube Into Windpipe","code_information":[{"code":"7716378","type":"CDM"},{"code":"450","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Foreign Body From Voice Box Using An En","code_information":[{"code":"7716379","type":"CDM"},{"code":"450","type":"RC"},{"code":"31530","type":"HCPCS"}],"standard_charges":[{"gross_charge":6444.0,"discounted_cash":2577.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Exploration Of Chest Cavity","code_information":[{"code":"7716380","type":"CDM"},{"code":"450","type":"RC"},{"code":"32100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2702.0,"discounted_cash":1080.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Massage Of Heart Muscle Through Chest Cavity","code_information":[{"code":"7716381","type":"CDM"},{"code":"450","type":"RC"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":7651.0,"discounted_cash":3060.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Central Venous Catheter For Infusion,","code_information":[{"code":"7716384","type":"CDM"},{"code":"361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":3448.0,"discounted_cash":1379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Blood Flow Assist Device In Aorta, Open","code_information":[{"code":"7716385","type":"CDM"},{"code":"450","type":"RC"},{"code":"33970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1569.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Placement Of Temporary Pacemaker Leads","code_information":[{"code":"7716386","type":"CDM"},{"code":"450","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":24453.0,"discounted_cash":9781.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Needle For Infusion Into Bone","code_information":[{"code":"7716387","type":"CDM"},{"code":"450","type":"RC"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Needle Or Catheter Into A Vein","code_information":[{"code":"7716388","type":"CDM"},{"code":"450","type":"RC"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Needle Into Scalp Vein, Patient Young","code_information":[{"code":"7716389","type":"CDM"},{"code":"450","type":"RC"},{"code":"36405","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Aspiration Of Fluid From Sac That Covers The Heart","code_information":[{"code":"7716390","type":"CDM"},{"code":"450","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1788.0,"discounted_cash":715.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Central Venous Catheter For Infusion","code_information":[{"code":"7716391","type":"CDM"},{"code":"450","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":2292.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Repair Of Blood Vessel Of Leg","code_information":[{"code":"7716392","type":"CDM"},{"code":"450","type":"RC"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2394.0,"discounted_cash":957.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introduction Of Catheter Into The Upper Or Lower M","code_information":[{"code":"7716393","type":"CDM"},{"code":"450","type":"RC"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.0,"discounted_cash":790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tying Or Biopsy Of Temporal Artery (Side Of Skull)","code_information":[{"code":"7716394","type":"CDM"},{"code":"450","type":"RC"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":5164.0,"discounted_cash":2065.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Removal Of Fluid From Chest Cavity","code_information":[{"code":"7716395","type":"CDM"},{"code":"450","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1892.0,"discounted_cash":756.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insertion Of Needle Into Upper Leg Or Neck Vein, P","code_information":[{"code":"7716397","type":"CDM"},{"code":"450","type":"RC"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":78.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Throat, Adenoids, Or Tonsils Procedure","code_information":[{"code":"7716403","type":"CDM"},{"code":"450","type":"RC"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biopsy Of Roof Of Mouth","code_information":[{"code":"7716404","type":"CDM"},{"code":"450","type":"RC"},{"code":"42100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2354.0,"discounted_cash":941.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Abscess, Cyst, Or Blood Accumulation O","code_information":[{"code":"7716407","type":"CDM"},{"code":"450","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":122.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision Of Abscess, Cyst, Or Blood Accumulation I","code_information":[{"code":"7716408","type":"CDM"},{"code":"450","type":"RC"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":234.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Incision And Drainage Of Roof Of Mouth Or Its Soft","code_information":[{"code":"7716409","type":"CDM"},{"code":"450","type":"RC"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Abscess, Cyst, Or Blood Accumulation U","code_information":[{"code":"7716410","type":"CDM"},{"code":"450","type":"RC"},{"code":"41017","type":"HCPCS"}],"standard_charges":[{"gross_charge":4763.0,"discounted_cash":1905.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drainage Of Tonsil Abscess","code_information":[{"code":"7716414","type":"CDM"},{"code":"450","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":424.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cardiopulmonary Resuscitation (Eg In Cardiac Arres","code_information":[{"code":"7716421","type":"CDM"},{"code":"450","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.0,"discounted_cash":376.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"External Shock To Heart To Regulate Heart Beat","code_information":[{"code":"7716423","type":"CDM"},{"code":"450","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":7214.0,"discounted_cash":2885.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Infusion Into Tissue For Therapy Or Prevention Up","code_information":[{"code":"7716425","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Infusion Into A Vein For Therapy Prevention Or Dia","code_information":[{"code":"7716427","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":96.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Analysis Of Nasal Resistance During Breathing","code_information":[{"code":"7716435","type":"CDM"},{"code":"450","type":"RC"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":220.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Evaluation, Testing, And Programming Adjustment Of","code_information":[{"code":"7716438","type":"CDM"},{"code":"450","type":"RC"},{"code":"93284","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":56.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Crtical Care 1St 30-74 Min","code_information":[{"code":"7716439","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3705.0,"discounted_cash":1482.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Critical Care Add Hr","code_information":[{"code":"7716440","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1096.0,"discounted_cash":438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Department Visit, Low To Moderately Seve","code_information":[{"code":"7716441","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":355.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Department Visit, Moderately Severe Prob","code_information":[{"code":"7716442","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":492.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Department Visit, Problem Of High Severi","code_information":[{"code":"7716443","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1951.0,"discounted_cash":780.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Emergency Department Visit, Problem With Significa","code_information":[{"code":"7716444","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2904.0,"discounted_cash":1161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Physician Direction Of Emergency Advanced Life Sup","code_information":[{"code":"7716445","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2525.0,"discounted_cash":1010.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Exc Benign Lesion Trunk, Arm, Leg 1.1-2.0 Cms 11402","code_information":[{"code":"7716504","type":"CDM"},{"code":"510","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":844.56,"discounted_cash":337.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":563.0,"discounted_cash":225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":1407.6,"discounted_cash":563.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Biopsy Of Vulva Or Perineum, Each Seperate Additional Lesion 56606","code_information":[{"code":"7716505","type":"CDM"},{"code":"510","type":"RC"},{"code":"56606","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.55,"discounted_cash":23.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":35.73,"discounted_cash":14.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":59.55,"discounted_cash":23.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Profee Price"}]},{"description":"Room/Bed: Pcu","code_information":[{"code":"7716506","type":"CDM"},{"code":"206","type":"RC"}],"standard_charges":[{"gross_charge":2527.0,"discounted_cash":1010.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screening Pelvic Exam, G0101","code_information":[{"code":"7716514","type":"CDM"},{"code":"510","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Profee Price"},{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"},{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Xr Pyelogram Antegrade","code_information":[{"code":"7717467","type":"CDM"},{"code":"320","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.0,"discounted_cash":513.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pulm Reh Inc Resp Func 15Min Units","code_information":[{"code":"7717500","type":"CDM"},{"code":"948","type":"RC"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pulm Reh Inc Resp Func 15Min Minutes","code_information":[{"code":"7717504","type":"CDM"},{"code":"948","type":"RC"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record","code_information":[{"code":"7717608","type":"CDM"},{"code":"999","type":"RC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record","code_information":[{"code":"7717614","type":"CDM"},{"code":"999","type":"RC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Thyroxine (T4) Lvl","code_information":[{"code":"7717818","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Helicobacter Pylori Poc","code_information":[{"code":"7717989","type":"CDM"},{"code":"300","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.63,"discounted_cash":49.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Stool Occult Blood Poc","code_information":[{"code":"7717991","type":"CDM"},{"code":"300","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.48,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"},{"gross_charge":29.0,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Tech Price"}]},{"description":"Hsv Culture","code_information":[{"code":"7718089","type":"CDM"},{"code":"300","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":58.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Holter Monitor","code_information":[{"code":"7718237","type":"CDM"},{"code":"93227","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.01,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Ambulatory Global Price"}]},{"description":"Suture Vicryl 4-0 27In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718239","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 3-0 54In Ligapak Reel Undyed 1 Strand/Pk J285G Uni-Direct Coat Braid Polyglactin 910","code_information":[{"code":"7718240","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 4-0 27In 1/2 Circ Sh Taper Point Undyed 1 Strand/Pk J415H Uni-Direct Coat Braid","code_information":[{"code":"7718243","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Ethibond Excel 2-0 30In 1/2 Circ Ct-1 Taper Point Green 1 Strand/Pk X423H Uni-Direct","code_information":[{"code":"7718244","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,2-0 Ethibond Ct-1/Cr8                          Cx22D","code_information":[{"code":"7718245","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Ti-Cron #2 30In 1/2 Circ Hgs-21 Taper Point Blue 88863113-81 Silicone Coat Braid Pes 37Mm","code_information":[{"code":"7718246","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl #0 54In Ties Undyed 1 Strand/Pk J608H Uni-Direct Coat Braid Polyglactin 910 W/O Needle","code_information":[{"code":"7718247","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sut,10-0 Ethilon Cs160-6 9000G","code_information":[{"code":"7718248","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl #1 54In Ties Std Short Len Violet 1 Strand/Pk J617H Uni-Direct Coat Braid Polyglactin","code_information":[{"code":"7718249","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 5-0 54In Ligapak Reel Undyed 1 Strand/Pk J283G Uni-Direct Coat Braid Polyglactin 910","code_information":[{"code":"7718250","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 2-0 54In Ligapak Reel Undyed 1 Strand/Pk J286G Uni-Direct Coat Braid Polyglactin 910","code_information":[{"code":"7718251","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture 4-0 Ethilon        699G P-3 18 Inch","code_information":[{"code":"7718252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Nylon Ethilon 9-0 5In 3/8 Circ Bv130-5 Multipass Taper Point Black 1 Strand/Pk 2809G","code_information":[{"code":"7718253","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 4-0 54In Ligapak Reel Undyed 1 Strand/Pk J284G Uni-Direct Coat Braid Polyglactin 910","code_information":[{"code":"7718254","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Nylon Ethilon 10-0 5In 3/8 Circ Bv75-4 Taper Point Black 1 Strand/Pk 2850G Uni-Direct Monofil","code_information":[{"code":"7718255","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl #0 27In 5/8 Circ Ur-5 Taper Point Violet 1 Strand/Pk J376H Uni-Direct Coat Braid","code_information":[{"code":"7718256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 10-0 12In Eye Compound Curve Csc-6 Dbl-Arm Ultima Spatula Revers Cut Blue 1 Strand/Pk","code_information":[{"code":"7718257","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Nylon Ethilon 5-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Pliabilized","code_information":[{"code":"7718258","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl #0 27In 1/2 Circ Sh Taper Point Undyed 1 Strand/Pk J418H Uni-Direct Coat Braid","code_information":[{"code":"7718259","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl #0 36In 1/2 Circ Ct-1 Taper Point Violet 1 Strand/Pk J346H Uni-Direct Coat Braid","code_information":[{"code":"7718260","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand 5-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Black 1","code_information":[{"code":"7718261","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Nylon Ethilon 5-0 18In 3/8 Circ Pc-1 Multipass Precision Cosmetic Prime Convent Cut","code_information":[{"code":"7718262","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl #1 27In 1/2 Circ Mo-4 Taper Point Violet 1 Strand/Pk J437H Uni-Direct Coat Braid","code_information":[{"code":"7718263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand 6-0 18In 3/8 Circ Tg140-8 Dbl-Arm Spatulated Micro-Point Revers Cut Ethalloy","code_information":[{"code":"7718264","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 2-0 36In 1/2 Circ Ctb-1 Blunt Point Ethiguard Undyed 1 Strand/Pk Jb945H Uni-Direct","code_information":[{"code":"7718265","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Nylon Ethilon 6-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Pliabilized","code_information":[{"code":"7718266","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand 6-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Pliabilized","code_information":[{"code":"7718267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,7-0 Ethilon P-1   1696G","code_information":[{"code":"7718268","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Ti-Cron 2-0 18In 1/2 Circ P-24 Prem Revers Cut Surgalloy Blue 8886305953 Silicone Coat Braid","code_information":[{"code":"7718269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 3-0 27In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Pliabilized","code_information":[{"code":"7718270","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Ti-Cron 4-0 18In 3/8 Circ P-13 Prem Revers Cut Surgalloy White 8886286234 Silicone Coat Braid","code_information":[{"code":"7718271","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 4-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Pliabilized","code_information":[{"code":"7718272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Plain Gut 6-0 18In 3/8 Circ Pc-1 Multipass Precision Point Cosmetic Prime Convent Cut","code_information":[{"code":"7718273","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,4-0 Chromic He-4 G-3793","code_information":[{"code":"7718274","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 2-0 27In 1/2 Circ Sh Taper Point Undyed 1 Strand/Pk J417H Uni-Direct Coat Braid","code_information":[{"code":"7718275","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 2-0 27In 5/8 Circ Ur-6 Taper Point Violet 1 Strand/Pk J602H Uni-Direct Coat Braid","code_information":[{"code":"7718276","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 5-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Natural Brown 1","code_information":[{"code":"7718277","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,2/O Steel Ct-1    M682G","code_information":[{"code":"7718278","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 3-0 36In 1/2 Circ Ctb-1 Blunt Point Ethiguard Undyed 1 Strand/Pk Jb944 Uni-Direct Coat","code_information":[{"code":"7718279","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 3-0 27In 1/2 Circ Rb-1 Taper Point Ethalloy Violet 1 Strand/Pk J305H Uni-Direct Coat","code_information":[{"code":"7718280","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,4-0 Prolene Pc-5  8631G","code_information":[{"code":"7718281","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Prolene 4-0 36In 1/2 Circ Rb-1 Dbl-Arm Taper Point Ethalloy Blue 1 Strand/Pk 8557H Uni-Direct","code_information":[{"code":"7718282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 3-0 27In 1/2 Circ Sh Taper Point Undyed 1 Strand/Pk J416H Uni-Direct Coat Braid","code_information":[{"code":"7718283","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pp Prolene Size 5-0 36In 1/2 Circ Rb-1 Blue 8556H Uni-Direct Monofil Nonabsorbable","code_information":[{"code":"7718284","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 3-0 27In 3/8 Circ Fs-1 Revers Cut Undyed 1 Strand/Pk J442H Uni-Direct Coat Braid","code_information":[{"code":"7718285","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 7-0 30In 3/8 Circ Bv-1 Dbl-Arm Taper Point Blue 4 Strands/Pk M8703 Uni-Direct Pp","code_information":[{"code":"7718286","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 4-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Blue 1 Strand/Pk","code_information":[{"code":"7718287","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 3-0 27In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718288","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 6-0 30In 3/8 Circ Bv-1 Dbl-Arm Taper Point Ethalloy Blue 1 Strand/Pk 8709H Uni-Direct","code_information":[{"code":"7718289","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 4-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Blue 1 Strand/Pk","code_information":[{"code":"7718290","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture 7-0 Prolene       8703H Bv-1","code_information":[{"code":"7718291","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Prolene 5-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Blue 1 Strand/Pk","code_information":[{"code":"7718292","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 6-0 18In 3/8 Circ P-1 Multipass Precision Point Prime Revers Cut Blue 1 Strand/Pk","code_information":[{"code":"7718293","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii 4-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718294","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,4-0 Ethibond V-5  X935H","code_information":[{"code":"7718295","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Pds Ii 5-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718296","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 6-0 18In 3/8 Circ Bv-1 Dbl-Arm Taper Point Ethalloy Blue 1 Strand/Pk 8806H Uni-Direct","code_information":[{"code":"7718297","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 2-0 27In 1/2 Circ Cp-1 Revers Cut Undyed 1 Strand/Pk J266H Uni-Direct Coat Braid","code_information":[{"code":"7718298","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 4-0 18In 3/8 Circ Pc-1 Multipass Precision Cosmetic Prime Convent Cut Pliabilized","code_information":[{"code":"7718299","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 5-0 18In 1/2 Circ P-2 Precision Point Prime Revers Cut Ethalloy Undyed 1 Strand/Pk","code_information":[{"code":"7718300","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture 6-0 Vicryl Ps-3   J499G","code_information":[{"code":"7718301","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture,Vicryl 6-0 P-3    J492G","code_information":[{"code":"7718302","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture,Vicryl 6-0 S-24   J552G","code_information":[{"code":"7718303","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 7-0 18In 3/8 Circ Tg140-8 Dbl-Arm Micro-Point Spatula Revers Cut Violet 1 Strand/Pk","code_information":[{"code":"7718304","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Nylon Ethilon 4-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Clear 1","code_information":[{"code":"7718305","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 4-0 27In 1/2 Circ Rb-1 Taper Point Ethalloy Undyed 1 Strand/Pk J214H Uni-Direct Coat","code_information":[{"code":"7718306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 5-0 27In 3/8 Circ Fs-2 Revers Cut Undyed 1 Strand/Pk J421H Uni-Direct Coat Braid","code_information":[{"code":"7718307","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture,0 Chromic Ties    S114H","code_information":[{"code":"7718308","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Pds Ii 3-0 27In 1/2 Circ Ct-1 Taper Point Violet 1 Strand/Pk Z338H Uni-Direct Monofil","code_information":[{"code":"7718309","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Ss 4-0 14In Ts/V-26 Dbl-Arm Tapercut Strt Cut Silver 2 Strands/Pk 540G Monofil","code_information":[{"code":"7718310","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Plain Gut 3-0 27In 3/8 Circ Fs-2 Revers Cut Yellow Tan 1 Strand/Pk H822H Uni-Direct Monofil","code_information":[{"code":"7718311","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Plain Gut 4-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Yellowish Tan 1","code_information":[{"code":"7718312","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Plain Gut 3-0 27In 1/2 Circ Ct Taper Point Yellowish Tan 1 Strand/Pk 852H Uni-Direct Monofil","code_information":[{"code":"7718313","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Ethilon Size2 Ties S246H Nonabsorbable","code_information":[{"code":"7718314","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Nylon Ethilon #2 20In 3/8 Circ Lr Revers Cut Black 1 Strand/Pk 460T Uni-Direct Monofil 75Mm","code_information":[{"code":"7718315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Nylon Ethilon 2-0 18In 3/8 Circ Fs Revers Cut Black 1 Strand/Pk 664H Uni-Direct Monofil 26Mm","code_information":[{"code":"7718316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Nylon Ethilon 3-0 18In 3/8 Circle Fs-1 Reverse Cutting Black 1Strand/Pk 12/Bx 663G Uni-Direct","code_information":[{"code":"7718317","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Nylon Ethilon 3-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Pliabilized","code_information":[{"code":"7718318","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene #0 30In 1/2 Circ Ctb-1 Blunt Point Ethiguard Blue 1 Strand/Pk Pb21H Uni-Direct","code_information":[{"code":"7718319","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene #0 30In 1/2 Circ Mo-6 Taper Point Blue 1 Strand/Pk 8418H Uni-Direct Monofil Pp 26Mm","code_information":[{"code":"7718320","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene #1 30In 1/2 Circ Ctb-1 Blue 1 Strand/Pk Pb20H Uni-Direct Monofil Pp 36Mm W/O Pledget","code_information":[{"code":"7718321","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 2-0 30In 1/2 Circ Ct-2 Taper Point Blue 1 Strand/Pk 8411H Uni-Direct Monofil Pp 26Mm","code_information":[{"code":"7718322","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 2-0 30In 1/2 Circ Ct-1 Taper Point Blue 1 Strand/Pk 8423H Uni-Direct Monofil Pp 36Mm","code_information":[{"code":"7718323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand #0 30In Ties Black 6 Strands/Pk A306H Uni-Direct Wax Coat Braid W/O Needle","code_information":[{"code":"7718324","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand #1 24In Ties Black 13 Strands/Pk Sa77G Uni-Direct Wax Coat Braid W/O Needle","code_information":[{"code":"7718325","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Perma-Hand #0 30In 1/2 Circ Sh Taper Point Black 1 Strand/Pk K834H Uni-Direct Wax Coat","code_information":[{"code":"7718326","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand #0 18In 3/8 Circ Fsl Revers Cut Black 1 Strand/Pk 678G Uni-Direct Wax Coat","code_information":[{"code":"7718327","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand 2-0 30In 1/2 Circ Sh Taper Point Black 1 Strand/Pk K833H Uni-Direct Wax Coat","code_information":[{"code":"7718328","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand 2-0 18In Ties Black 12 Strands/Pk A185H Uni-Direct Wax Coat Braid W/O Needle","code_information":[{"code":"7718329","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand 3-0 18In Ties Black 12 Strands/Pk A184H Uni-Direct Wax Coat Braid W/O Needle","code_information":[{"code":"7718330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Silk Perma-Hand 3-0 18In 3/8 Circ Fs-1 Revers Cut Black 1 Strand/Pk 684H Uni-Direct Wax Coat","code_information":[{"code":"7718332","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Perma-Hand 3-0 18In 1/2 Circ Sh-1 Control Release Taper Point Black 8 Strands/Pk C003D","code_information":[{"code":"7718333","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,Silk Braided 4/0  Sa63H","code_information":[{"code":"7718334","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Perma-Hand 4-0 18In 3/8 Circ Fs-2 Revers Cut Black 1 Strand/Pk 683G Uni-Direct Wax Coat","code_information":[{"code":"7718335","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,Mersilene 1 Lr    R495T","code_information":[{"code":"7718336","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Monocryl 4-0 27In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718337","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii 3-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718338","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 5-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut J493G 1 Strand/Pk","code_information":[{"code":"7718339","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture 1 Chromic Ties    S115H","code_information":[{"code":"7718340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 5-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718341","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii 6-0 18In 3/8 Circ P-1 Multipass Precision Point Prime Revers Cut Ethalloy Undyed 1","code_information":[{"code":"7718342","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture,O Chromic Sh      G124H","code_information":[{"code":"7718343","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Chromic Gut #0 27In 1/2 Circ Ct-1 Taper Point Natural Brown Undyed 1 Strand/Pk 812H Monofil","code_information":[{"code":"7718344","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut #1 18In 1/2 Circ Mo-4 Control Release Taper Point Natural Brown 8 Strands/Pk","code_information":[{"code":"7718345","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,O Chromic Ur-4    U256H","code_information":[{"code":"7718346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Chromic Gut #1 36In 1/2 Circ Ct Taper Point Natural Brown Undyed 1 Strand/Pk 915H Monofil","code_information":[{"code":"7718347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut #1 36In 1/2 Circ Ctx Taper Point Natural Brown Undyed 1 Strand/Pk 905H Monofil","code_information":[{"code":"7718348","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 2-0 27In 5/8 Circ Ur-6 Taper Point Natural Brown 1 Strand/Pk N878H Monofil 26Mm","code_information":[{"code":"7718349","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 2-0 36In 1/2 Circ Ct Ties Taper Point Natural Brown 1 Strand/Pk 913H Monofil 40Mm","code_information":[{"code":"7718350","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,2-0 Chromic Ur-5  U245H","code_information":[{"code":"7718351","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Chromic Gut 2-0 27In 1/2 Circ Sh Taper Point Natural Brown Undyed 1 Strand/Pk G123H Monofil","code_information":[{"code":"7718352","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 3-0 36In 1/2 Circ Ct Taper Point Natural Brown Undyed 1 Strand/Pk 912H Monofil","code_information":[{"code":"7718353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture,2-0 Chromic Reel  L113G","code_information":[{"code":"7718354","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Chromic Gut 3-0 27In 1/2 Circ Sh Taper Point Natural Brown Undyed 1 Strand/Pk G122H Monofil","code_information":[{"code":"7718355","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 4-0 27In 3/8 Circ Fs-2 Revers Cut Natural Brown Undyed 1 Strand/Pk 635H Monofil","code_information":[{"code":"7718356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 4-0 27In 1/2 Circ Sh Taper Point Natural Brown Undyed 1 Strand/Pk G121H Monofil","code_information":[{"code":"7718357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Chromic Gut 4-0 27In 1/2 Circ Rb-1 Taper Point Undyed Naturally Brown U203H Ecm 17Mm Absorb","code_information":[{"code":"7718358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,5-0 Chromic Rb-1  U202H","code_information":[{"code":"7718359","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 2-0 18In 1/2 Circ Ctb-1 Control Release Blunt Point Ethiguard Undyed 8 Strands/Pk","code_information":[{"code":"7718360","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl #0 18In 1/2 Circ Ctb-1 Control Release Blunt Point Ethiguard Undyed 8 Strands/Pk Jb840","code_information":[{"code":"7718361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii #0 36In 1/2 Circ Ctb-1 Blunt Point Ethiguard Violet 1 Strand/Pk Zb346 Uni-Direct","code_information":[{"code":"7718362","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii #0 36In 1/2 Circ Ctxb Blunt Point Ethiguard Violet 1 Strand/Pk Zb370 Uni-Direct","code_information":[{"code":"7718363","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii #0 60In 1/2 Circ Tp-1 Taper Point Loop Violet 1 Strand/Pk Z991G Uni-Direct Monofil","code_information":[{"code":"7718364","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii #1 36In 1/2 Circ Ctxb Blunt Point Ethiguard Violet 1 Strand/Pk Zb371 Uni-Direct","code_information":[{"code":"7718365","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii #1 36In 1/2 Circ Ctb-1 Blunt Point Ethiguard Violet 1 Strand/Pk Zb347 Uni-Direct","code_information":[{"code":"7718366","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Pds Ii 2-0 27In 1/2 Circ Ct-2 Taper Point Violet 1 Strand/Pk Z333H Uni-Direct Monofil","code_information":[{"code":"7718367","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,3-0 Chromic Keith  654H","code_information":[{"code":"7718368","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Nylon Ethilon 5-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut 1666H","code_information":[{"code":"7718369","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 3-0 48In 1/2 Circ Sh Dbl-Arm Taper Point Ethalloy Blue 1 Strand/Pk 8534H Uni-Direct","code_information":[{"code":"7718370","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,5 Mersilene Bp-1   Rs21","code_information":[{"code":"7718371","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":97.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7718372","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wax Bone Synthetic","code_information":[{"code":"7718373","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Monocryl #1 27In 1/2 Circ Mo-4 Control Release Taper Point Violet 4 Strands/Pk Yy70G","code_information":[{"code":"7718374","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,4/0 Nurolon Ps2   5654H","code_information":[{"code":"7718375","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Plain Gut #0 54In Ties Std Short Len Yellowish Tan 1 Strand/Pk S104H Uni-Direct Monofil W/O","code_information":[{"code":"7718376","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture,2-0 Silk Reel     La55G","code_information":[{"code":"7718377","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture 4-0 Silk Cr/8     C004D Sh-1","code_information":[{"code":"7718378","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Carticel Essential   82004","code_information":[{"code":"7718379","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk 6-0 18In 3/8 Circ B-1 Dbl-Arm Revers Cut Black 8065195601 Braid Twist Dr Charles 7.92Mm","code_information":[{"code":"7718380","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Nylon 10-0 12In 1/2 Circ Cu-5 Dbl-Arm Spatulated Black 8065192101 Monofil 5.51Mm","code_information":[{"code":"7718381","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture V151B Backgard Disc Vb1 Neuro","code_information":[{"code":"7718382","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X60Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718383","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Pds Ii 2-0 27In 1/2 Circ Sh Taper Point Ethalloy Violet 1 Strand/Pk Z317H Uni-Direct Monofil","code_information":[{"code":"7718384","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Heimlich Chest Valve    373460","code_information":[{"code":"7718385","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Flush Ti Humeral","code_information":[{"code":"7718387","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Nylon Ethilon 4-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Pliabilized","code_information":[{"code":"7718388","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Pe.R.I Xs Non-Locking Timax Calcaneal F/Small Frag Frx Ns","code_information":[{"code":"7718389","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Pe.R.I 122.2Mm 9-Hole 1/3 Tubul Compress Non-Locking Timax Fibula F/Small Frag Frx Ns","code_information":[{"code":"7718390","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Pe.R.I 16Mm Lg Spider Shape Non-Locking Timax Lower Extrem F/Small Frag Frx Ns","code_information":[{"code":"7718391","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Pe.R.I 20Mm Lg Spider Shape Non-Locking Timax Lower Extrem F/Small Frag Frx Ns","code_information":[{"code":"7718392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Pe.R.I 25Mm Lg Spider Shape Non-Locking Timax Offst Lower Extrem F/Small Frag Frx Ns","code_information":[{"code":"7718393","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Vertex Select Sofamor Danek 13Mm Spinal Triflat Conn Ss","code_information":[{"code":"7718395","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":964.0,"discounted_cash":385.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 4.5X36Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7718396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tubing Silastic 0.055X0.092Inx7Frx39.37In Silicone Elastomer Smooth Pliable Lf Strl","code_information":[{"code":"7718398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Dressing Neg Press Med 12X19Cm Foam Lf W/1-Dressing 2-26Cm X 32Cm Clear Film Fit Pad Strl Disp","code_information":[{"code":"7718399","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Glidecath 5Frx100Cm 25Cm/40Cm Sims2 Sgl Braid Lg Lumen Small-Profile Periph","code_information":[{"code":"7718400","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Introducer Cath Flexor Sheath Guiding 6Frx45Cm Ansel Modif Rdc Tip Reinforc Check-Flo Hemostat Vlv","code_information":[{"code":"7718401","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Introducer Cath S-Mak Mini Access Sheath 4Frx10Cm Coaxial W/0.018In 40Cm Nt/Pt Tip Gw Stiff Dil","code_information":[{"code":"7718402","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Torcon Nb Advantage Selective 7Frx100Cm Mont1 4Sp 16-Wire Braid Short Tip","code_information":[{"code":"7718403","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Hi-Torque Supracore Delivery 0.035Inx190Cm 5Cm Tip Strt Steerability Support Ss","code_information":[{"code":"7718404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Hi-Torque Supracore Delivery 0.035Inx300Cm 5Cm Tip Strt Steerability Support Ss","code_information":[{"code":"7718405","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Monocryl 4-0 18In 3/8 Circ P-3 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Disc Diamond 25.4 Mm    Sil-14","code_information":[{"code":"7718407","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Selective Specialty 5Frx65Cm Ang Mp Tegtmeyer Nsp Pe 0.035In Gw 630Psi","code_information":[{"code":"7718408","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Glidecath 5Frx65Cm 25Cm/40Cm Cob1 Dbl Braid Lg Lumen Small-Profile Periph","code_information":[{"code":"7718409","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Ambi Classic Imhs Chs 12.7X115Mm Compress Lag 21Mm Thread Std Ss Hex Head Im Strl","code_information":[{"code":"7718410","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protector Tissue Alexis O Wound Retractor Lg 25Cm 9-14Cm Rigid Self-Retaining Lf Strl Disp F/360Deg","code_information":[{"code":"7718411","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":59.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Ambi Classic Imhs Chs 12.7X125Mm Compress Lag 21Mm Thread Std Ss Hex Head Im Strl","code_information":[{"code":"7718412","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":318.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ambi Classic Imhs Chs 12.7X19Mm Compress Lag 21Mm Thread Std Ss Hex Head Im Strl 6/Bx","code_information":[{"code":"7718413","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Cannul 7X20Mm Ti Alloy W/O Sheath F/Graft Fixat Strl Acl/Pcl Btb Knee","code_information":[{"code":"7718415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4.5X16Mm Cannul Compress Lck Full Thread Non Self-Tap Std Cortic Ss Hex Socket Head","code_information":[{"code":"7718416","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 6.5X60Mm Compress Lck 16Mm Partial Thread Cancell Ss Hex Socket Head Malleolar","code_information":[{"code":"7718417","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 2.4X124Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718418","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 2.4X140Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718419","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 2.4X152Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718420","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 2.4X178Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 2.4X216Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 2.4X229Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 2.4X241Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718424","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 3.2X114Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 3.2X127Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 3.2X140Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718427","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 3.2X165Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718428","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 4.8X222Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718429","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 4.8X260Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718430","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 4.8X298Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718431","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 4.8X318Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718432","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 4.8X337Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 4.8X356Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X298Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718435","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X318Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718436","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X337Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X356Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718438","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X375Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718439","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X394Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718440","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X413Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718441","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Rush 6.4X432Mm Rod Perm Ss Im Ns","code_information":[{"code":"7718442","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Staple Bone Fixat Synergy Reg Lg 14X22Mm Barbed Press-Fit Std Offst Cocr Hip W/Spike","code_information":[{"code":"7718443","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Staple Bone Fixat 12-8604","code_information":[{"code":"7718444","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strap Cath Holder 2X22In Leg Elastic Hk-Loop Close Lf Ns F/Foley","code_information":[{"code":"7718445","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5X100Mm Cannul Lag 40Mm Thread Self-Drilling/Tapping Cancell Timax Cut 4-Flute Ns","code_information":[{"code":"7718446","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":741.0,"discounted_cash":296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 8X40Mm Cannul Lag 24Mm Thread Self-Drilling/Tapping Cancell Timax Cut 4-Flute F/Trauma","code_information":[{"code":"7718447","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 8X45Mm Cannul Lag 24Mm Thread Self-Drilling/Tapping Cancell Timax Cut 4-Flute F/Trauma","code_information":[{"code":"7718448","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 8X50Mm Cannul Lag 24Mm Thread Self-Drilling/Tapping Cancell Timax Cut 4-Flute F/Trauma","code_information":[{"code":"7718449","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X22Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718450","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X26Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718451","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X28Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718452","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X30Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718453","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X44Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718454","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X52Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718455","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X54Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718456","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X56Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718457","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X70Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718458","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Unitrax 47Mm Endo Unipol Compo Primary Modul Cocr Hip Strl","code_information":[{"code":"7718459","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X75Mm Full Thread Self-Tap Solid Cancell Ti Hex Head Ns","code_information":[{"code":"7718460","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X25Mm Lck Full Thread Solid Cancell Timax Hex Head F/Large Frag Plate System","code_information":[{"code":"7718461","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X30Mm Lck Full Thread Solid Cancell Timax Hex Head F/Large Frag Plate System","code_information":[{"code":"7718462","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X55Mm Lck Full Thread Solid Cancell Timax Hex Head F/Large Frag Plate System","code_information":[{"code":"7718463","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Unitrax 48Mm Endo Unipol Compo Primary Modul Cocr Hip Strl","code_information":[{"code":"7718464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Unitrax 49Mm Endo Unipol Compo Primary Modul Cocr Hip Strl","code_information":[{"code":"7718465","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X95Mm Lck Full Thread Solid Cancell Timax Hex Head F/Large Frag Plate System","code_information":[{"code":"7718466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Unitrax 54Mm Endo Unipol Compo Primary Modul Cocr Hip Strl","code_information":[{"code":"7718467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Unitrax 55Mm Endo Unipol Compo Primary Modul Cocr Hip Strl","code_information":[{"code":"7718468","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X105Mm Lck Full Thread Solid Cancell Timax Hex Head F/Large Frag Plate System","code_information":[{"code":"7718469","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X110Mm Lck Full Thread Solid Cancell Timax Hex Head F/Large Frag Plate System","code_information":[{"code":"7718470","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5X115Mm Solid Cancell","code_information":[{"code":"7718471","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X70Mm Lck Lag 40Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718472","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X75Mm Lck Lag 40Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718473","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X80Mm Lck Lag 40Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X95Mm Lck Lag 40Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718475","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X75Mm Lck Lag 22Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718476","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X80Mm Lck Lag 22Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718477","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X85Mm Lck Lag 22Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718478","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 6.5X90Mm Lck Lag 22Mm Partial Thread Solid Cancell Timax Hex Head F/Large Frag","code_information":[{"code":"7718479","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 14-Hole Std 95Deg Angle Supracond","code_information":[{"code":"7718480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2586.0,"discounted_cash":1034.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 57Mm 7-Hole 1.5Mm Dynamic Compress Lck Ti Cntr Lt Condylar F/2.7Mm Screw Ns","code_information":[{"code":"7718481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":429.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 4X70Mm 1.5In Tiip Qck-Conn Solid F/Small Frag System","code_information":[{"code":"7718482","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 57Mm 7-Hole 1.5Mm Dynamic Compress Lck Ti Cntr Rt Condylar F/2.7Mm Screw Ns","code_information":[{"code":"7718483","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":429.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 39Mm 7-Hole Dynamic Compress Lck Ti Cntr Rt Condylar F/2Mm Screw Ns","code_information":[{"code":"7718484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":904.0,"discounted_cash":361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 39Mm 7-Hole Compress Lck Ti Cntr Lt Condylar F/2Mm Screw Ns","code_information":[{"code":"7718485","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":904.0,"discounted_cash":361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 34Mm 3-Hole L-Shaped Oblique Ti Cntr Lt F/2.7Mm Screw Ns","code_information":[{"code":"7718486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 39Mm 5-Hole 1/4 Tubul Ti Cntr F/2.7Mm Screw Mini Frag Set Collar Ns","code_information":[{"code":"7718487","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Agent Hemostat Oxidiz Regen Cellulose 2X14In Absorb Surgicel Original Loose Knit 5Yr Shelf Life","code_information":[{"code":"7718488","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":493.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 1/4 Tubul Ti Cntr F/2.7Mm Screw Mini Frag Set Collar Ns","code_information":[{"code":"7718489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Cable Ortho Dall-Miles 2Mm Vitallium W/Medium Sleeve Strl","code_information":[{"code":"7718490","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1542.0,"discounted_cash":616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 50Mm 4/9-Hole Mini T-Shaped Ti Cntr F/2Mm Screw Ns","code_information":[{"code":"7718491","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Cable Dall-Miles 2Mm Med Bead Single-Sided Vitallium Strl","code_information":[{"code":"7718492","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 32Mm 6-Hole 1Mm Strt Contour Dynamic Compress Ti Cntr Tray F/2Mm Screw Maxillofacial","code_information":[{"code":"7718493","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":346.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 50Mm 3/9-Hole T-Shaped Compress Lck Ti Cntr F/1.5Mm Screw Ns","code_information":[{"code":"7718494","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 50Mm 4/9-Hole T-Shaped Compress Lck Ti Cntr F/1.5Mm Screw Ns","code_information":[{"code":"7718495","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 54Mm Ss F/2Mm Cortic Screw","code_information":[{"code":"7718496","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho Lc-Dcp 7Mm Mini/Small Round Flat Head Ti F/3.6/4Mm Screw Ns","code_information":[{"code":"7718497","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2X24Mm Full Thread Std Cortic Ti Cruciform Recess Head Hand F/Modular System Ns","code_information":[{"code":"7718498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2X18Mm Full Thread Std Cortic Ti Cruciform Recess Head Hand F/Modular System Ns","code_information":[{"code":"7718499","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X20Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Radial Hand F/Modular Mini","code_information":[{"code":"7718500","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X9Mm Full Thread Std Cortic Ti Cruciform Recess Head Hand F/Modular Mini Frag","code_information":[{"code":"7718501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 12-Hole Univ Ti Ribbon Reconstruct F/3.5Mm Screw","code_information":[{"code":"7718502","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1131.0,"discounted_cash":452.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Odc Hip Stem         6070-0730 # 7","code_information":[{"code":"7718503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4488.0,"discounted_cash":1795.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5X60Mm Cannul Lag 40Mm Thread Self-Drilling/Tapping Cancell Timax Cut 4-Flute Ns","code_information":[{"code":"7718504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":281.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 16-Hole Univ Ti Ribbon Reconstruct F/3.5Mm Screw","code_information":[{"code":"7718505","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":806.0,"discounted_cash":322.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2X22Mm Full Thread Std Cortic Ti Cruciform Recess Head Hand F/Modular System Ns","code_information":[{"code":"7718506","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X18Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Radial Hand F/Modular Mini","code_information":[{"code":"7718507","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X34Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718508","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X46Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718509","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X38Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718510","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Localization Mammalock Homer 20Ga 3Cm J-Curved Reposition Formable Three Ringed Hndl Gold","code_information":[{"code":"7718511","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Localization Mammalock Homer 20Ga 5Cm J-Curved Reposition Formable Three Ringed Hndl Gold","code_information":[{"code":"7718512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Localization Mammalock Homer 20Ga 7.5Cm J-Curved Reposition Formable Three Ringed Hndl Gold","code_information":[{"code":"7718513","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Canister Suction Berkeley Safetouch W/Tissue Trap Collect Lid Sealing Cap 3/8In Strl Disp","code_information":[{"code":"7718514","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 3-0 18In 1/2 Circ Sh-1 Control Release Taper Point Violet 8 Strands/Pk J772D","code_information":[{"code":"7718515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Mayo            1824-6D","code_information":[{"code":"7718517","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X50Mm Bipol Modul Cup Ball Cocr Hip Brown","code_information":[{"code":"7718518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4430.0,"discounted_cash":1772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 80Mm Lag Self-Tap Std Timax Supracond Hip Keyed","code_information":[{"code":"7718519","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":340.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Lacrimal Intubat Crawford Ii 0.01In Probe 0.02In Tubing Ss Silicone Canalicular Olive Tip W/O","code_information":[{"code":"7718520","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Catheter Hemodialysis Schon Niagara Xl Acute Basic 14Frx15Cm 2Lumen Silicone Side Hole Tip","code_information":[{"code":"7718521","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Catheter Hemodialysis Schon Niagara Xl Acute Basic 14Frx20Cm 2Lumen Silicone Side Hole Tip Clip","code_information":[{"code":"7718522","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter,Balloon     420-2040S 12X4 (Powerflex)","code_information":[{"code":"7718523","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":423.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Cre Dilatat Endo 6Frx180Cm 18-20Mmx8Cm Esoph Pyloric Colonic Fixed Wire Pebax Strl 5/Bx","code_information":[{"code":"7718525","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":446.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Basket Stone Retriev Escape Bagley 1.9Fr 11-15Mm Sheath 120Cm Urethral Helical 4-Wire Knotted","code_information":[{"code":"7718526","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Introducer Cath Prelude Snap Pacer 9Frx13Cm Split Seamless Hemostat Vlv Robust Sidept W/Dil","code_information":[{"code":"7718527","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Endcap Ortho 1Cm","code_information":[{"code":"7718528","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Stylet Lead Access 0.014In Strt Extend Taper Ball Tip Transvenous Gray Knob Ss","code_information":[{"code":"7718529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extractor Surg 3.5Mm F/Conical Screw","code_information":[{"code":"7718530","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":346.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extractor Surg 4.5Mm Conical Screw","code_information":[{"code":"7718531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":346.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg Cutter 3X2.7Mm Square Ring Peek Lf Disp","code_information":[{"code":"7718532","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg Cutter 3.5X2.7Mm Square Ring Peek Lf Disp","code_information":[{"code":"7718533","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg Cutter 4.5X2.7Mm Square Ring Peek Lf Disp","code_information":[{"code":"7718534","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 6.5Mm Square Ring Peek Lf Disp","code_information":[{"code":"7718535","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Introducer Cath S-Mak Mini Access Sheath 5Frx10Cm Coaxial W/0.018In 40Cm Nt/Pt Tip Gw Stiff Dil","code_information":[{"code":"7718536","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Amplatz Super Stiff 0.035Inx75Cm 7Cm Tip Strt Short Taper Spring Coil Soft Flat","code_information":[{"code":"7718537","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Glidecath 5Frx100Cm 25Cm/40Cm Sim1 Sgl Braid Lg Lumen Small-Profile Periph","code_information":[{"code":"7718538","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X41Mm Bipol Modul Cup Ball Cocr Hip Rust","code_information":[{"code":"7718539","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4430.0,"discounted_cash":1772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Tubing Ext Custom Medex Jp4","code_information":[{"code":"7718540","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 2-0 27In 3/8 Circ Fs-1 Revers Cut Undyed 1 Strand/Pk J443H Uni-Direct Coat Braid","code_information":[{"code":"7718541","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 5X55Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718542","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X60Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718543","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X65Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718544","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Repliform 2X7Cm Matrix Frz-Dry Nonabsorbable Slf-Anchor Transvaginal Collagen","code_information":[{"code":"7718545","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2427.0,"discounted_cash":970.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Stent Ureteral 7-14Frx22Cm 13Cm C-Flex W/Release Sleeve Position F/Endoureterotomy","code_information":[{"code":"7718546","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":435.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drain Flexima Apd 14Frx25Cm Pig Loop Reg Duromet Lck W/Metal/Flexible Stiffen Cann Glidex","code_information":[{"code":"7718547","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Humeral Global Advantage 48X18Mm Cocr","code_information":[{"code":"7718548","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5249.0,"discounted_cash":2099.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Sheath Urological 8/10Frx70Cm 35Cm Coaxial Stylet Dilator Ss Hydrphil Lf","code_information":[{"code":"7718549","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Tempo Selective 5Frx65Cm J-Curved 3 0.6 Nsh Braid Thrulumen Neon Tip Visceral","code_information":[{"code":"7718550","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Collar Cervical Procare Patriot Univ 1.75In/2.5In/3In/3.5In Adult Neck 1Pc Trachea Open/Closed Cell","code_information":[{"code":"7718551","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Shaver Sterling Cuda Arthro 4.8Mmx13Cm Lg Hub Magenta 6000Rpm","code_information":[{"code":"7718552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cutter,High Speed Drill Qd8-6B","code_information":[{"code":"7718553","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3.8Mm Im Trocar Qck-Conn Calib Point","code_information":[{"code":"7718554","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Iv Jelco Non-Safety 18Ga 1 3/4In Fep Polymer Green Translucent Strt Hub Sharp Bevel J-Point","code_information":[{"code":"7718555","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg Anspach 5Mm Ball High-Speed Flute Coarse Cut Strt Short Attach Carbide","code_information":[{"code":"7718556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Jl4 3-Stage Braid Thrulumen High Flow","code_information":[{"code":"7718557","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Jl5 3-Stage Braid Thrulumen High Flow","code_information":[{"code":"7718558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cath, 6Fr Jr3.5 100Cm   533619","code_information":[{"code":"7718559","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Jr4 3-Stage Braid Thrulumen High Flow","code_information":[{"code":"7718560","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Jr5 Nsh 3-Stage Braid Thrulumen High","code_information":[{"code":"7718561","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Mpb2 2Sh 3-Stage Braid Thrulumen High","code_information":[{"code":"7718562","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Al1 3-Stage Braid Thrulumen High Flow","code_information":[{"code":"7718563","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Al2 Nsh 3-Stage Braid Thrulumen High","code_information":[{"code":"7718564","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Ar1 Modif 3-Stage Braid Thrulumen High","code_information":[{"code":"7718565","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cath, 6Fr Lcb 100Cm     533672","code_information":[{"code":"7718566","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Rcb 3-Stage Braid Thrulumen High Flow","code_information":[{"code":"7718567","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Ima Nsh 3-Stage Braid Thrulumen High","code_information":[{"code":"7718568","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Selective 6Frx110Cm 145Deg Ang Pig 6Sh 2-Stage Braid Thrulumen","code_information":[{"code":"7718569","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Infiniti Selective 6Frx100Cm Williams 3Drc Nsh 3-Stage Braid Thrulumen Soft","code_information":[{"code":"7718570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Introducer Cath Preludepro Sheath 6Frx11Cm W/O Gw Green Satin","code_information":[{"code":"7718571","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Introducer Cath Prelude Sheath 6Frx23Cm W/O Gw Green Satin","code_information":[{"code":"7718572","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Emerald Workhorse 0.035Inx150Cm 7Cm Tip 3Mm J-Tip Fixed Core Flex Std Ptfe","code_information":[{"code":"7718573","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Emerald 0.035Inx260Cm 5Cm 3Mm J-Tip Fixed Core Flex Firm Ptfe","code_information":[{"code":"7718574","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Emerald Workhorse 0.035Inx150Cm 7Cm Tip Strt Fixed Core Flex Std Ptfe","code_information":[{"code":"7718575","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Emerald Workhorse 0.035Inx260Cm 7Cm Tip Strt Fixed Core Flex Std Ptfe","code_information":[{"code":"7718576","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Cable Ortho Dall-Miles 2Mm Vitallium W/Beaded Med Sleeve Strl","code_information":[{"code":"7718577","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1469.0,"discounted_cash":587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilator Vasc Std 4Frx20Cm Taper Nylon Hydrphil Lf Marker Strl Disp 0.035In Gw","code_information":[{"code":"7718578","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Applier Clip Ligaclip Endo Multi 5Mmx11.4In Ligat Rotat Shaft Endpoint Ti Lf Strl Disp F/20-Medium","code_information":[{"code":"7718579","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":307.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pack Cath Lab W/Pvp Scrub Waterprf Label Surg Gown Safety Scalpel Needle Holder","code_information":[{"code":"7718580","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Marker Radiology Endo W/5Ml Prefilled Syringe Spot Strl","code_information":[{"code":"7718581","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Ankle Joint Mba 10X15Mm Cannul Biconical Barrel-Shaped Soft Thread Slot Ti Subtalar","code_information":[{"code":"7718582","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4845.0,"discounted_cash":1938.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Electrosurgical 3Fr Short 105Cm Bugbee Tip Flex Uret Strl Disp","code_information":[{"code":"7718585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Endo Endotrac Hook Triang F/Plantar Fasciotomy","code_information":[{"code":"7718586","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vascular Emerald 0.025In 150Cm 7Cm Tip 3Mm J-Tip Flexible Fixed Core Ptfe","code_information":[{"code":"7718587","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Emerald 0.025Inx150Cm 7Cm Strt Tip Fixed Core Flex Std Ptfe F/Diagnostic","code_information":[{"code":"7718588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Splint Nasal Extern Denver Sm Med 35X65Mm 2Pc Adhes Alum Velcro W/Applicator 1500","code_information":[{"code":"7718589","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Splint Nasal Extern Denver Lg 43X69Mm 2Pc Adhes Dorsal Pad Alum Velcro W/Alcohol Wipe Skin Prep","code_information":[{"code":"7718590","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Achilles Tendon Whole                         450101","code_information":[{"code":"7718591","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8125.0,"discounted_cash":3250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Gii Quickanchor Plus 2.4Mm Nonabsorbable W/#2 Ethibond Cp-2 Needle Rotator Cuff Pe","code_information":[{"code":"7718592","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1065.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Bln Uromax Ultra Dilatat Endo High Press 5.8X24Frx75Cm 4Cm Ureteral Taper Dist End Tip","code_information":[{"code":"7718593","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1187.0,"discounted_cash":474.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Syringe Angiography Sgl Injecting Pp 150Ml Taper Luer Tip Fill Tube Seal 2-Plunger F/Power Angiomat","code_information":[{"code":"7718594","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit, Drill 3.5Mm 7117-0073 7117-0073","code_information":[{"code":"7718595","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 3.5Mmx4.5In Tc-100 Ss Qck-Conn F/Cortical Screw","code_information":[{"code":"7718596","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":179.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bag Press Infusion Net Back 0-300Mmhg 500Ml Lg Oval Bulb Stopck Air Control Color-Cd Gauge Lf Disp","code_information":[{"code":"7718597","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bone Fixat Peri-Loc 1.6X150Mm Kirschner Temp Trocar Point Ss Strl - D","code_information":[{"code":"7718598","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Peri-Loc 2X150Mm Kirschner Temp Trocar Point Ss Strl","code_information":[{"code":"7718599","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Tempo Selective 5Frx100Cm Adult Mp A2 2Sh Sm Braid Thrulumen Neon Tip Gray","code_information":[{"code":"7718600","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Uhr 28X44Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7718601","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4191.0,"discounted_cash":1676.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stopcock Iv High Press Med 3-Way Male Ll Female Fit On/Off Vlv W/Rotator Lf Strl","code_information":[{"code":"7718602","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Interference Intrafix Cannul 7-9X30Mm Taper Nonabsorbable Tibial Acl Soft Tissue","code_information":[{"code":"7718603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit,Sterile Component ***Sterile Components********","code_information":[{"code":"7718604","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Mersilene 2-0 5Mmx12In 1/2 Circ Ctx Dbl-Arm Taper Point White 1 Strand/Pk Rs22 Uni-Direct","code_information":[{"code":"7718605","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Duraloc 28X50Mm Cementls 10Deg Angle Lat Marathon","code_information":[{"code":"7718607","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4143.0,"discounted_cash":1657.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur S-Rom Ztt Size 14 Lg Cementls Conical Modul Porous Prox Hip","code_information":[{"code":"7718608","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7166.0,"discounted_cash":2866.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Selective 6Frx110Cm Strt Pig 6Sh 3-Stage Braid Thrulumen High","code_information":[{"code":"7718609","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur S-Rom 28Mm Std +0Mm Neck 11/13 Taper Modul M-Specification Cocr Hip","code_information":[{"code":"7718610","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Dx Custom Angiogram F/0.010-0.97Mm Gw","code_information":[{"code":"7718611","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Super Torque Plus Selective 6Frx100Cm Jl3.5 Nsh 3-Stage Braid Thrulumen High","code_information":[{"code":"7718612","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Smartset,Tubing    001.4","code_information":[{"code":"7718613","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Urology Pledget          Pcp30","code_information":[{"code":"7718614","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Port Infusion M.R.I. Non-Power Inject Intermed Implant 10Fr Plastic 2Lumen Open Suture","code_information":[{"code":"7718615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1632.0,"discounted_cash":652.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Canister Neg Press Invia Liberty 800Ml Overflow Bacteria Filter Pcte Lf W/Solidifier Sealing Cap","code_information":[{"code":"7718617","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Self-Centering 28X44Mm Bipol Modul Cup Ball Cocr Hip Gray","code_information":[{"code":"7718618","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4262.0,"discounted_cash":1704.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone 4-Hole L-Shaped Cancell F/4.5/5Mm Screw","code_information":[{"code":"7718619","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tubing,Sterile Iv  1C8160","code_information":[{"code":"7718620","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7718621","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Prosthesis Penile Ambicor 14Mmx20Cm Saline-Filled 2Pc Inflate Pre-Connected Penoscrotal Cylindr","code_information":[{"code":"7718622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":25761.0,"discounted_cash":10304.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Chs Twist 4.5Mm 5-Hole Chuck End Lf Mercury-Free F/Ambi Classic System","code_information":[{"code":"7718623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Dressing Neg Press Sm 8X10Cm Foam Lf W/1-Dressing 1-26Cm X 32Cm Clear Film Fit Pad Strl Disp","code_information":[{"code":"7718624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7718625","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 4X120Mm 135Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7718627","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Chs 4.5X64Mm Full Thread Self-Tap Cortic Ss Hex Head Supracond Hip Ns","code_information":[{"code":"7718628","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cube Bone Graft Readigraft 1X1X1Cm Allograft Void Filler 40Ml Frz-Dry Cancell Ambient Store 5Yr","code_information":[{"code":"7718629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3678.0,"discounted_cash":1471.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl Plus #1 36In 1/2 Circ Ctb-1 Blunt Point Ethiguard Undyed 1 Strand/Pk Vcpb947H","code_information":[{"code":"7718630","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3X17Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7718631","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X15Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7718632","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Urological Zipwire Std 0.035Inx150Cm 3Cm Tip Strt Shaft Hydrphil","code_information":[{"code":"7718633","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Urological Zipwire Vntbr-032 Std 0.035Inx150Cm 3Cm Gastro Angle Strt Tip Steer Shaft","code_information":[{"code":"7718634","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Urological Zipwire M006630222B1 0.035Inx150Cm 3Cm Strt Taper Tip Super Steer Stiff Shaft","code_information":[{"code":"7718635","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Omnifit Eon Size 6 9.6Mm Dist 40X120Mm Cement Primary Extend Offst Cocr 127Deg Angle","code_information":[{"code":"7718636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":12644.0,"discounted_cash":5057.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Eon Size 7 10.4Mm Dist 45X130Mm Cement Primary Extend Offst Cocr 127Deg Angle","code_information":[{"code":"7718637","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":12644.0,"discounted_cash":5057.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Eon Size 9 12.6Mm Dist 51X140Mm Cement Primary Extend Offst Cocr 127Deg Angle","code_information":[{"code":"7718638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":12644.0,"discounted_cash":5057.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Reflexion Sm Stem Cement Metatarsal","code_information":[{"code":"7718641","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3413.0,"discounted_cash":1365.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Reflexion Med Phalangeal Base","code_information":[{"code":"7718642","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3953.0,"discounted_cash":1581.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 2.4Mm Mtp F/Reflexion Toe System Ns","code_information":[{"code":"7718643","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 2.4Mm Phalangeal","code_information":[{"code":"7718644","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7718645","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shaft Bone Graft Vertigraft 8-18X60Mm Allograft Frz-Dry Texture Cortic Fibula Segment Ant","code_information":[{"code":"7718646","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Arthro Zone Specific Ii Double-Armed Lg Eyelet F/Repair Meniscal Nitinol Strl","code_information":[{"code":"7718647","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 1.1Mm 150Mm 1-End Non-Threaded Spade Point Ss F/3Mm Cannul Screw Ns Asif","code_information":[{"code":"7718648","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin,Covers (Blue)  10-1-002","code_information":[{"code":"7718649","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guard Pin Cover Lg Thermoplast Strl Oxboro F/0.141-0.188In Steinmann K-Wire Red Lf","code_information":[{"code":"7718650","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pump Vacuum Mystic Ii Extract Mity 50Mm M-Style Mushroom Cup","code_information":[{"code":"7718651","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Ortho Zms 2.4Mm 100Cm Smooth/Blunt Tip Ss F/Intramedullary Nail Strl","code_information":[{"code":"7718652","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Curette Vacuum Aspirat Berkeley Vacurette 7Mm Adult Curve Dist Tip Thin-Wall Taper End Pull-Open","code_information":[{"code":"7718653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Trident 28Mm +10Mm Neck Compo C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7718654","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2805.0,"discounted_cash":1122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Hemodialysis Hemostar Chronic Std 14.5Frx24Cm 19Cm 2-Large Lumen Pur Rt Sublavian Strt","code_information":[{"code":"7718655","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1419.0,"discounted_cash":567.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Hemodialysis Hemostar Chronic Std 14.5Frx28Cm 23Cm 2-Large Lumen Pur Lt Sublavian Strt","code_information":[{"code":"7718656","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1419.0,"discounted_cash":567.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X54Mm Bipol Modul Cup Ball Cocr Hip Blue","code_information":[{"code":"7718657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4262.0,"discounted_cash":1704.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Sv Workhorse 0.018In Short 300Cm 5Cm Dist Taper Shapeable Strt Tip Steer Ss Ptfe","code_information":[{"code":"7718658","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Twist Drill Bit 3.2Mm  160052","code_information":[{"code":"7718659","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Pe.R.I 67.3X37.3Mm Lg Non-Locking Timax Calcaneal F/Small Frag Frx Ns","code_information":[{"code":"7718660","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1769.0,"discounted_cash":707.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X30Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X32Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Tc-100 Lg 4.5X46Mm Lag Full Thread Self-Tap Cortic Ss Hex Head","code_information":[{"code":"7718663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Xia Ii 6.5X40Mm Open Polyaxial Cort/Canc Pedicle Ti 60Deg Gray 50Deg Angle Top","code_information":[{"code":"7718664","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4909.0,"discounted_cash":1963.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Connector Spinal Mac 42-51Mm Multiaxial Ti","code_information":[{"code":"7718665","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5841.0,"discounted_cash":2336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X18Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7718666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Secure Fixat Stayfix Sm 3.5X4In Hydrocol Stab Absorb Ndlless Water-Resist F/5-14Fr Percutan","code_information":[{"code":"7718668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X10Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X18Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X20Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X26Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X30Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X32Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X34Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X36Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X38Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X40Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718678","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X42Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718679","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X44Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X46Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X48Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X50Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Et Tube Flex-Guide Bougie 15Frx60Cm Adult Smooth Round Edge Pe Lf Ns Disp 10/Bx","code_information":[{"code":"7718684","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X6Mm Compress Lck Full Thread Std Cortic Ti Hex Socket Spheric Head F/Small Frag","code_information":[{"code":"7718685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Duraprep 26Ml             8630","code_information":[{"code":"7718686","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cuff 4X18In Color Cuff Sgl Bladder Dual Port Quick-Connector Adult Red W/Limb Protect Sleeve Disp","code_information":[{"code":"7718687","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cuff 4X24In Color Cuff Sgl Bladder Dual Port Quick-Connector Adult Yellow Disp Tourniquet Strl Lf","code_information":[{"code":"7718688","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Uhr 28X47Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7718689","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4078.0,"discounted_cash":1631.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bandage Wound Adhes Non-Adher Island 4X8In 2In X 5 1/2In Pad Acrylic Tape Rect Multi-Layer Covaderm","code_information":[{"code":"7718690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pin,Orthosorb Tapered   841070 50X1.3","code_information":[{"code":"7718691","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stopcock,High Pressure H1Flc","code_information":[{"code":"7718693","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Frs 2X11Mm Compress Shank Self-Drilling/Tapping Twist-Off Ti Taper Flattened Head Ns","code_information":[{"code":"7718694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter,Balloon     419-6020X Opta Lp 6X2","code_information":[{"code":"7718695","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Ureteral 10Frx0.050Inx54Cm Taper 2Lumen W/0.039In Gw","code_information":[{"code":"7718696","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Chisel Reproc 10Mm Strt F/Reshape Femur Neck Strl","code_information":[{"code":"7718697","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Chisel Long 16Mm Strt Osteotome F/Hip Impingement Correct Ns","code_information":[{"code":"7718698","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel Long 25Mm Strt Osteotome F/Hip Impingement Correct Ns","code_information":[{"code":"7718699","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel Long 5Mm Strt F/Hip Impingement Correct Ns","code_information":[{"code":"7718700","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Xia Ii 6X60Mm Strt Non-Hexagonal Smooth Ti Ns","code_information":[{"code":"7718701","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":420.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheath,Avanti 7Fr     402-607X","code_information":[{"code":"7718702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Opta Lp 5X8 419-5080L","code_information":[{"code":"7718703","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon,Opta Lp 4X2  419-4020L","code_information":[{"code":"7718704","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Emerald Workhorse 0.025Inx260Cm 7Cm Tip 3Mm J-Curve Fixed Core Flex Ptfe","code_information":[{"code":"7718705","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Opti Lp 5X2 110 Cm   419-5020L","code_information":[{"code":"7718706","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon,Opta Lp 8X2  419-8020S","code_information":[{"code":"7718707","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":367.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X38Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7718708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X50Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7718709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Electrosurgical Cautery 6In Tip Blade Modif Insul Extend Ptfe Coat Ltx","code_information":[{"code":"7718710","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Interference Intrafix Cannul 8-10X30Mm Taper Nonabsorbable Tibial Acl Soft Tissue","code_information":[{"code":"7718711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Bit Drill Arthro Passing Wire 2.4Mm Guidepin Acl W/Gw Lf Strl Disp F/Graft Transfix I","code_information":[{"code":"7718712","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":376.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Arthro Transtibial Acl W/Threaded Fixat Pin Hall Style Sagittal Drill Tip Guide 30Mm Depth Mark","code_information":[{"code":"7718713","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Tubing Irrigat Tip F/Hi-Speed E9010 Drill","code_information":[{"code":"7718714","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg 5X30Mm 8Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7718715","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg 3X48Mm Spinal Round Fine 140-170-Grit E9000 Diamond Strl F/Otology Neuro","code_information":[{"code":"7718716","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg 3X38Mm 8Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7718717","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bur,2.5X48Mm Round Cut   E8225","code_information":[{"code":"7718718","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Handle Suction Via-Guard Yankauer Std Adult Vasc Multi-Ported Flush-Fit Conn W/Poole Converter","code_information":[{"code":"7718719","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg 5X38Mm 8Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7718720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cement Bone Simplex P 40Gm/20Ml High Viscos Full Dose Polymethyl Methacrylate F/Accolade System","code_information":[{"code":"7718723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 7 81/56Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Lt Knee","code_information":[{"code":"7718724","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8056.0,"discounted_cash":3222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Genesis Ii 35Mm 9Mm 3-Peg Resurfac Post Retain Anatomic Uhmwpe","code_information":[{"code":"7718725","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3311.0,"discounted_cash":1324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Snare Vasc Amplatz Goose Neck 25Mm Loop 120Cm 90Deg Angle Coaxial W/6Fr 102Cm Cath Intro Gold","code_information":[{"code":"7718726","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Cre Dilatat Endo 6Frx180Cm 8-10Mmx8Cm Esoph Pyloric Colonic Fixed Wire Pebax Lf Strl","code_information":[{"code":"7718727","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":993.0,"discounted_cash":397.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bur 5X48 Rnd Carbide  E8250Lso","code_information":[{"code":"7718728","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 3X48Mm 8Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7718729","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Angiography Inflat Presto Basix High Press W/30Ml Barrel 40Atm Disp","code_information":[{"code":"7718730","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bone Fixat Peri-Loc 1.25X150Mm Kirschner Temp Trocar Point Ss Strl","code_information":[{"code":"7718731","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak Mini 2.3/3.4Mm Taper Cannul Ns F/Standard Bone Screw","code_information":[{"code":"7718732","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Dressing Ear Glasscock Surg 5.5X6In Adult Postauricular Lt/Rt Curve Custom Mold Non-Adhesive","code_information":[{"code":"7718733","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Catheter Nephrostomy Flexima 10Frx25Cm Reg Duromet W/Metal/Flexible Stiffen Cann Lck Pig Glidex","code_information":[{"code":"7718734","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Biopsy Temno Semi-Automated 20Ga 11Cm Bevel Tip Adjust Echo Cm Depth W/19Ga 6Cm Coaxial Intro","code_information":[{"code":"7718735","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Temno Semi-Automated 20Ga 20Cm Bevel Tip Adjust Echo Cm Depth W/19Ga 15Cm Intro Green","code_information":[{"code":"7718736","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Biopsy Temno Std Semi-Automated 18Ga 11Cm Bevel Tip Coaxial Compact Adjust Echo Mark Hndl","code_information":[{"code":"7718737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Biopsy Temno Std Semi-Automated 18Ga 15Cm Bevel Tip Coaxial Compact Adjust Echo Mark Hndl","code_information":[{"code":"7718738","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Performa 6Frx125Cm Jl4 Wing Hub Pebax Nylon 0.038In Gw","code_information":[{"code":"7718739","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Infiniti Selective 6Frx125Cm Jr4 Nsh 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7718740","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reamer Surg Arthro 8Mm Std 5Mm Femur Tunnel Round Back Edge Sharp Head Medial Portal Cannul Calib Ss","code_information":[{"code":"7718741","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":969.0,"discounted_cash":387.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chips Bone Graft Readigraft 1-8Mm Void Filler 30Ml Frz-Dry Crush Cancell Ambient Store 5Yr Shelf","code_information":[{"code":"7718742","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1778.0,"discounted_cash":711.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7718743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":674.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tubing Silastic 9Fr 0.118X0.071In Silicone Elastomer F/General Purp","code_information":[{"code":"7718744","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":122.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial Lcs Complete Size 4 Cement Stemmed Post Stabil Keeled Tricompart Mobile","code_information":[{"code":"7718745","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10491.0,"discounted_cash":4196.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Connector Spinal Mac 38-43Mm Multiaxial Ti","code_information":[{"code":"7718746","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4377.0,"discounted_cash":1750.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill P.F.C Sigma Twist Steinmann Pin 3.2Mmx3In Unicompart Strl","code_information":[{"code":"7718747","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":406.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial Lcs Complete Size 5 Cement Stemmed Post Stabil Keeled Tricompart Mobile","code_information":[{"code":"7718748","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":10491.0,"discounted_cash":4196.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 5 81Mm/53Mm 10Mm Curve Post Stabil Rotat Platform Gvf Pe","code_information":[{"code":"7718749","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5384.0,"discounted_cash":2153.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sut,3-0 Vicryl Fs Cr/8  J787D 18 Inch","code_information":[{"code":"7718750","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant,Restore    1855-20-500 Orthobiologic Soft Tissue","code_information":[{"code":"7718751","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11153.0,"discounted_cash":4461.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Urological Sensor 0.035Inx150Cm 3Cm Strt Floppy Tip Dual-Flex Nitinol Tungsten Hydrphil","code_information":[{"code":"7718752","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial P.F.C Sigma Size 3 70Mm/46Mm 10Mm Curve Post Stabil Rotat Platform Gvf Pe","code_information":[{"code":"7718753","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5384.0,"discounted_cash":2153.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial Lcs Complete Size 3 Cement Stemmed Post Stabil Keeled Tricompart Mobile","code_information":[{"code":"7718754","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":10491.0,"discounted_cash":4196.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X49Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7718755","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4078.0,"discounted_cash":1631.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X29Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7718756","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Syringe Inject Mark V Fasturn Sgl 150Ml Tube Quick Fill Strl Disp F/Medrad Injector","code_information":[{"code":"7718757","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade,Saw         5627-85-000","code_information":[{"code":"7718758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial Lcs Complete Size 2.5 Cement Stemmed Post Stabil Keeled Tricompart Mobile","code_information":[{"code":"7718759","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10491.0,"discounted_cash":4196.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar P.F.C Sigma 35Mm Sm 3-Peg Oval Dome Uhmwpe","code_information":[{"code":"7718760","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3030.0,"discounted_cash":1212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Seal Endo Instrument Adjust F/Biopsy Port 0-6Fr","code_information":[{"code":"7718761","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X30Mm Compress Lck Dual Lead Full Thread Cancell Ss Hex Socket Head Prox Medial","code_information":[{"code":"7718762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X35Mm Compress Lck Dual Lead Full Thread Cancell Ss Hex Socket Head Prox Medial","code_information":[{"code":"7718763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4.5X58Mm Compress Lck Std Full Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7718764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4.5X62Mm Compress Lck Std Full Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7718765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4.5X66Mm Compress Lck Std Full Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7718766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4.5X68Mm Compress Lck Std Full Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7718767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 11X124Mm 9-Hole Dynamic Compress Lck Ss Limit-Cont Basic Dist Metaphyseal F/3.5Mm","code_information":[{"code":"7718768","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":456.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 11X72Mm 5-Hole Dynamic Compress Lck Ss Limit-Cont Basic Dist Metaphyseal F/3.5Mm","code_information":[{"code":"7718769","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":374.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 70Mm 6-Hole Strt Dynamic Compress Lck Ss Reconstruct Pelvic F/3.5Mm Screw Sm Frag Set","code_information":[{"code":"7718770","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 196Mm 11-Hole Broad Curve Pre-Contoured Dynamic Compress Lck Ss Limit-Cont Basic","code_information":[{"code":"7718771","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 196Mm 11-Hole Narrow Dynamic Compress Lck Ss Limit-Cont Basic Metaphyseal F/4.5Mm","code_information":[{"code":"7718772","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Capsurefix Surescan Novus Implant Perm Bipol 6Frx52Cm 10Mm Space Atrial Ventric Strt Tip","code_information":[{"code":"7718773","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":4062.0,"discounted_cash":1624.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Finger Joint Swanson Size 00 Flex Prox Mtp W/O Grommet","code_information":[{"code":"7718774","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2365.0,"discounted_cash":946.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint Swanson Size 0 Flex Prox Mtp W/O Grommet","code_information":[{"code":"7718775","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2365.0,"discounted_cash":946.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint Swanson Size 6 Flex Prox Mtp W/Grommet","code_information":[{"code":"7718776","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2993.0,"discounted_cash":1197.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint Swanson Size 7 Flex Prox Mtp W/Grommet","code_information":[{"code":"7718777","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2365.0,"discounted_cash":946.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint Swanson Size 8 Flex Prox Mtp W/Grommet","code_information":[{"code":"7718778","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2365.0,"discounted_cash":946.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint Swanson Size 9 Flex Prox Mtp W/Grommet","code_information":[{"code":"7718779","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2365.0,"discounted_cash":946.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Xia Ii 6X80Mm Strt Non-Hexagonal Smooth Ti Ns","code_information":[{"code":"7718780","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1105.0,"discounted_cash":442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X34Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7718781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Line Angiography Excite Tubing 0.071X59In Nylon Pur Clear High Press Co-Extruded Flex Airless Rotat","code_information":[{"code":"7718782","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Distal        1067-0011","code_information":[{"code":"7718783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupling Extern Fixat 5Mm Rod To Rod Hoffmann Ii Compact Pvc-Free Mri-Safe Strl","code_information":[{"code":"7718784","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1267.0,"discounted_cash":506.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 3Mm Periarticular Hoffmann Ii Compact F/Foot Ankle System W/4-Pin Pvc-Free","code_information":[{"code":"7718785","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1329.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 3Mm Short 80Mm 20Mm Thread Self-Tapping/Drilling Apex Ss F/Thr Ns","code_information":[{"code":"7718786","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 5X200Mm Conn Hoffmann Ii Compact Yellow Carbon Fiber Mri-Safe","code_information":[{"code":"7718787","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 5X150Mm Conn Hoffmann Ii Compact Yellow Carbon Fiber Mri-Safe","code_information":[{"code":"7718788","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilator Vasc Std 9Frx20Cm Lf Strl Disp 0.038In Gw","code_information":[{"code":"7718789","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Balloon,Opta Pro Pta 419-9040S 9 X 4 X 80","code_information":[{"code":"7718790","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon,Opta Pro Pta 419-0040S","code_information":[{"code":"7718791","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Emerald Workhorse 0.035Inx150Cm 20Cm Tip Strt Bentson Fixed Core Flex Floppy Ptfe","code_information":[{"code":"7718792","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Introducer Cath Brite Tip Sheath 6Fr Taper Dual Layer Slix Manicured Atraum W/Mini-Wire 35Mm Dilator","code_information":[{"code":"7718793","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheath,Brite-Tip      401-705M 5.5Cm","code_information":[{"code":"7718794","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Cath Brite Tip Sheath 7Fr Taper Dual Layer Slix Manicured W/Mini-Gw 35Mm Dilator 11Cm","code_information":[{"code":"7718795","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Introducer Cath Brite Tip Sheath 8Fr Taper Dual Layer Slix Manicured W/Mini-Gw 35Mm Dil 11Cm","code_information":[{"code":"7718796","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Introducer Cath Avanti Plus Sheath 9Fr Slix Hexa-Cuspid Hemostat Vlv Percutan W/0.035In Mini Gw 11Cm","code_information":[{"code":"7718797","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Snare Vasc Amplatz Goose Neck 10Mm Loop 120Cm 90Deg Angle Coaxial W/4Fr 102Cm Cath Intro Nitinol","code_information":[{"code":"7718799","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dilator Vasc Std 12Frx20Cm Lf Strl Disp 0.038In Gw","code_information":[{"code":"7718800","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Breast Spectrum Siltex 11.5-11.1Cm X 9.5-9.4Cm 5.1-6.3Cm Contour-Profile 275-330Ml","code_information":[{"code":"7718801","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5164.0,"discounted_cash":2065.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Monocryl 3-0 18In 3/8 Circ Ps-2 Multipass Precision Point Prime Revers Cut Undyed 1 Strand/Pk","code_information":[{"code":"7718802","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Monocryl 3-0 27In 1/2 Circ Sh Single-Arm Taper Point Undyed 1 Strand/Pk Y416H Uni-Direct","code_information":[{"code":"7718803","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Patellar P.F.C Sigma 32Mm Xs 3-Peg Oval Dome Uhmwpe","code_information":[{"code":"7718805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3030.0,"discounted_cash":1212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Prelude Sheath 7Frx23Cm W/O Gw Orange Satin","code_information":[{"code":"7718806","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Support,Arm Large  12-401 (Fax Order Is Required)!!!!!!!","code_information":[{"code":"7718809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X60Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7718810","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Iv Introcan Safety Auto Passive Shield 18Ga 1.25In Teflon Fep Green Strt Hub Univ Bevel","code_information":[{"code":"7718811","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Iv Introcan Safety Auto Passive Shield 20Ga 1.25In Teflon Fep Pink Strt Hub Univ Bevel Strl","code_information":[{"code":"7718812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Iv Introcan Safety Auto Passive Shield 22Ga 1In Teflon Fep Blue Strt Hub Univ Bevel Strl Lf","code_information":[{"code":"7718813","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Spinal Xia Ii 6X90Mm Strt Non-Hexagonal Smooth Ti Ns","code_information":[{"code":"7718814","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1693.0,"discounted_cash":677.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lc-Dcp 3.5X30Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Dist","code_information":[{"code":"7718815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lc-Dcp 3.5X34Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Dist","code_information":[{"code":"7718816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lc-Dcp 3.5X38Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Dist","code_information":[{"code":"7718817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 4X10Mm Cannul Compress Lck Partial Thread Cancell Ss Hex Socket Head Prox Tibial","code_information":[{"code":"7718818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X10Mm Compress Lck Dual Lead Full Thread Cancell Ss Hex Socket Head Prox Medial","code_information":[{"code":"7718819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X12Mm Compress Lck Dual Lead Full Thread Cancell Ss Hex Socket Head Prox Medial","code_information":[{"code":"7718820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 67Mm 3/5-Hole 1.5Mm T-Shaped Oblique Rt Angle Pre-Contoured Compress Lck Ss Prox","code_information":[{"code":"7718821","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Drain Wound Tls 10Fr 15Ml Cap Silicone","code_information":[{"code":"7718822","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":84.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip T's Red       Sc-5000-3R","code_information":[{"code":"7718823","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Cannul 7X20Mm Ti Alloy Round Head Taper Step W/Disposable Sheath F/Graft Fixat","code_information":[{"code":"7718824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Fluid Transfer Fill Aseptic W/600Ml Syringe Piercing Spike 48In Dual Check Vlv 10In Tubing Luer","code_information":[{"code":"7718825","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade,Beaver/Myringo. Bc377121 Lance Tip Narrow Shaft 45 Deg","code_information":[{"code":"7718826","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 28Mm -3Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7718827","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2798.0,"discounted_cash":1119.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent,Contour Peraflex 185-612 6X22  Soft","code_information":[{"code":"7718828","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Trigen Meta-Nail Pilot 4Mm Long 16.25In Qck-Conn Strl Disp","code_information":[{"code":"7718829","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Monocryl #0 36In 1/2 Circ Ct-1 Taper Point Undyed 1 Strand/Pk Y946H Uni-Direct Monofil","code_information":[{"code":"7718830","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Shaver Sterling Arthro Ultra-Aggressive 5.5Mmx13Cm 20Deg Spheric Reduce Hood Lg Hub Xsharp Blue","code_information":[{"code":"7718831","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilator Vasc Std 6Frx20Cm Lf Strl Disp 0.038In Gw","code_information":[{"code":"7718832","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tap Surg 3.5X70Mm","code_information":[{"code":"7718833","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":376.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill A.L.P.S 2.9X70Mm Cannul Strl","code_information":[{"code":"7718834","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X28Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7718835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X60Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7718836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X48Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X16Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7718838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":84.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X22Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7718839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":84.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X26Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7718840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X54Mm Cortic Ti Acl F/2.5Mm Hex Driver Graft Prep","code_information":[{"code":"7718841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":185.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cutter Arthro Std 4X8In","code_information":[{"code":"7718842","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2462.0,"discounted_cash":984.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cutter Arthro Std 6X8In","code_information":[{"code":"7718843","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2462.0,"discounted_cash":984.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cutter Arthro Std 8X8In","code_information":[{"code":"7718844","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2462.0,"discounted_cash":984.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Endo 4Mm Plunger","code_information":[{"code":"7718845","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Surg 8Mm F/Delivery Plunger Core","code_information":[{"code":"7718846","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide/Plunger 8Mm       252203 Clear Delivery","code_information":[{"code":"7718847","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro Std 4X4Mm","code_information":[{"code":"7718848","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro Std 6X6Mm","code_information":[{"code":"7718849","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro Std 8X8Mm","code_information":[{"code":"7718850","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Panalok Rc Quickanchor Plus Absorb W/2-#2 Braid White Panacryl Mo-7 Needle Rotator","code_information":[{"code":"7718851","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1107.0,"discounted_cash":442.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Arthro Rapidloc W/Pla Tophat/Backstop 2/0 Panacryl Load Absorb Braid Polylactic Acid Suture Strt","code_information":[{"code":"7718852","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Grasper Arthro Ideal Suture Retriever 15Deg Sharp Tip Lo-Pro","code_information":[{"code":"7718853","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":286.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Grasper Arthro Ideal Suture Retriever Shoulder 30Deg Strt Sharp Tip Lo-Pro Anchor Lf Disp","code_information":[{"code":"7718854","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":286.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Grasper Arthro Ideal Suture Retriever 15Cm Shoulder 60Deg Angle Sharp Tip Lo-Pro Pink","code_information":[{"code":"7718855","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":286.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Anchor Suture Rapidloc 12Deg Angle Curve Nonabsorbable W/#2/0 Ethibond Pla Tophat Backstop","code_information":[{"code":"7718856","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Panalok 3.5Mm Thread Post Absorb W/#2 Braid Panacryl Soft Tissue Plla Disp","code_information":[{"code":"7718857","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":340.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Panalok Rc Quickanchor Plus Absorb W/#2 Braid White Panacryl Cp-2 Needle Rotator Cuff","code_information":[{"code":"7718858","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1107.0,"discounted_cash":442.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Arthro 1.1Mmx15In F/Interference Screw Nitinol","code_information":[{"code":"7718859","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":84.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Profile Cannul 7X20Mm Ti Round Head Acl","code_information":[{"code":"7718860","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Profile Cannul 7X25Mm Ti Round Head Acl","code_information":[{"code":"7718861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Profile Cannul 7X30Mm Ti Round Head Acl","code_information":[{"code":"7718862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Profile Cannul 9X20Mm Ti Round Head Acl","code_information":[{"code":"7718863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Profile Cannul 9X25Mm Ti Round Head Acl","code_information":[{"code":"7718864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Profile Cannul 9X30Mm Ti Round Head Acl","code_information":[{"code":"7718865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Bioknotless Knotless Size 1 Absorb W/Disposable Driver Polylactic Acid Panacryl","code_information":[{"code":"7718866","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":458.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 2.9Mm F/Mitek Super/Rc/Gls","code_information":[{"code":"7718867","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Arthro 2.4Mmx18In Eyelet Bayonet Point F/Anteromedial Acl","code_information":[{"code":"7718868","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 50X50Mm 0.6Mm Compress Lck Ti F/1.5Mm Screw Orbital Floor Ns","code_information":[{"code":"7718869","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2952.0,"discounted_cash":1180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheeting Silastic 6X8In 0.01In Silicone Reinforc Translucent Lf Strl Implant Med Grd","code_information":[{"code":"7718870","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture #5 Ethibond Excel Mb66G Grn.  Br,5, V-37","code_information":[{"code":"7718871","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupling Extern Fixat Rod To Rod Hoffmann Ii Compact F/8Mm Post 5Mm Pin Pvc-Free Mri-Safe Strl","code_information":[{"code":"7718872","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1952.0,"discounted_cash":780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 5X150Mm C-Shaped 50Mm Thread Self-Tapping/Drilling Apex Ss F/Thr Ns","code_information":[{"code":"7718873","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Fastin 4X9.7Mm W/#2 Braid Green Ethibond Soft Tissue Dr Flock","code_information":[{"code":"7718874","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":286.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Fastin 5Mm Dual-Channeled W/#2 Ethibond Excel Needle Rotator Cuff Dr Flock","code_information":[{"code":"7718875","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Panalok Rc Arthro 3.2X25Mm F/Mitek Suture Anchor","code_information":[{"code":"7718876","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Panalok Arthro 3.5X18Mm F/4.5Mm Suture Anchor","code_information":[{"code":"7718877","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Panalok Rc Arthro 3.5X25Mm Shoulder F/Knotless Bioabsorbable Dual Suture Anchor Loop","code_information":[{"code":"7718878","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 3.2Mm Ss Shoulder Jacobs Chuck End F/Cortical Cancell Screw Washer","code_information":[{"code":"7718879","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":126.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Prolene 2-0 48In 1/2 Circ Sh Dbl-Arm Taper Point Ethalloy Blue 1 Strand/Pk 8533H Uni-Direct","code_information":[{"code":"7718880","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bone Fixat 1.6Mmx6In Kirschner Temp Thread Dbl-End Trocar Point Tip Ti Ns","code_information":[{"code":"7718881","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin,Bay W/Eyelet        219322","code_information":[{"code":"7718882","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Univent 8Mm 11.7/13.5X50Mm 50Ml Adult Oral Cuffed Hi-Vol Low-Pressure Tcb Type W/9Fr","code_information":[{"code":"7718883","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 4/3Mm Lg 80Mm 20Mm Thread Self-Drill Blunt Trocar Point Chondral Hip Femur","code_information":[{"code":"7718885","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":227.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 4Mm Sm Adjust Carbon Fiber F/Fixator System Mri-Safe Ns","code_information":[{"code":"7718886","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2936.0,"discounted_cash":1174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 8X200Mm Conn Dist Radial Carbon Fiber F/Medium Fixator System Ns","code_information":[{"code":"7718887","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupling Extern Fixat 3/4-5Mm Pin To Rod Hoffmann Ii Compact F/5Mm Post Pvc-Free Mri-Safe Strl","code_information":[{"code":"7718888","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X42Mm Bipol Modul Cup Ball Cocr Hip Rust","code_information":[{"code":"7718889","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3717.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl Plus #1 36In 1/2 Circ Ctxb Control Release Blunt Point Ethiguard Undyed 1 Strand/Pk","code_information":[{"code":"7718890","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Mat,Aquavac-S              100","code_information":[{"code":"7718891","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X52Mm Bipol Modul Cup Ball Cocr Hip Blue","code_information":[{"code":"7718892","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3717.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Gamma3 3.2X450Mm Kirschner Temp Strl F/Intramedullary Nailing System","code_information":[{"code":"7718893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Hammertoe Medium Ship 16Mm Length","code_information":[{"code":"7718894","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":494.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Asnis Iii 3.2Mm 300Mm Cannul Thread Ss Hip Femur F/5Mm Screw Insertion Im Nailing","code_information":[{"code":"7718895","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Concept Grafix Arthro Twist 2Mm Stop F/Patellar Tendon Graft Guide","code_information":[{"code":"7718896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4.5X16Mm Compress Lck Std Full Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7718897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Versanail 4.5X42Mm Full Thread Self-Tap Solid Cortic Ti Hex Head Non-Drive End Dist Prox","code_information":[{"code":"7718898","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture,2 Pds Cp          Z195T","code_information":[{"code":"7718899","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Iv Introcan Safety Auto Passive Shield 20Ga 1In Teflon Fep Pink Strt Hub Univ Bevel Strl Lf","code_information":[{"code":"7718900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Asnis Iii 6.5X90Mm Cannul 20Mm Thread Self-Drilling/Tapping Ti Hex Recess Drive Ankle","code_information":[{"code":"7718901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":826.0,"discounted_cash":330.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho Asnis Iii Round Drill Ti F/6.5/8Mm Cannul Screw Ns","code_information":[{"code":"7718902","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 3.5X80 Corti. 2347-20-80","code_information":[{"code":"7718903","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3.8Mmx15.5Cm Qck-Conn","code_information":[{"code":"7718904","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4.5Mm Quick-Coupling Solid","code_information":[{"code":"7718905","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":104.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X75Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7718906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X65Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7718907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X50Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7718908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X48Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7718909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X44Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7718910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X38Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7718911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5X220Mm Qck-Conn Ss Ns","code_information":[{"code":"7718912","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5X195Mm Qck-Conn W/100Mm Shank Ss","code_information":[{"code":"7718913","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 9X117Mm 10-Hole 1Mm 1/3 Tubul Contour Compress Lck Ss Limit-Cont Dist Fibula","code_information":[{"code":"7718914","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":253.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 9X141Mm 12-Hole 1Mm 1/3 Tubul Contour Compress Lck Ss Limit-Cont Dist Fibula","code_information":[{"code":"7718915","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Splint Ortho Strip Baseball 0.5X9In Finger End Pad W/Bulb Zimfoam","code_information":[{"code":"7718916","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Asnis Iii 6.5X85Mm Cannul 20Mm Thread Self-Drilling/Tapping Ti Hex Recess Drive Ankle","code_information":[{"code":"7718917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":298.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 0.078Inx2Mm Subtalar Reus","code_information":[{"code":"7718919","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X60Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7718920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Post Extern Fixat 5X140Mm 30Deg Angle Multi-Planar Pin To Rod Hoffmann Ii Compact Carbon Fiber","code_information":[{"code":"7718921","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 4.5X30Mm 4-Hole Thread Periarticular Hoffmann Ii Compact F/3/4Mm Sm Pin Pvc-Free","code_information":[{"code":"7718922","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1497.0,"discounted_cash":598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray,I&D            Sba23Cddcb Incision & Drainage Tray","code_information":[{"code":"7718923","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Biopince Device 18Ga 15Cm Coaxial Intro Echo Tip Strl Disp","code_information":[{"code":"7718924","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Biopince 17Ga 11.8Cm Echo Cm Depth W/Coaxial Intro F/Full Core Instrument 360-1580-01","code_information":[{"code":"7718925","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent,Ureteral 3.7X16   036316","code_information":[{"code":"7718926","type":"CDM"},{"code":"273","type":"RC"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Capsurefix Surescan Novus Implant Perm Bipol 6Frx45Cm 10Mm Space Atrial Ventric Strt Tip","code_information":[{"code":"7718927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3682.0,"discounted_cash":1472.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Uhr 28X46Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7718928","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4014.0,"discounted_cash":1605.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Hip Cement Omnifit 12Mm Univ Centralizer Dist Femur Strl","code_information":[{"code":"7718929","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":172.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent,Contour 6.0X20   180-220","code_information":[{"code":"7718930","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Introducer Cath Prelude Snap 7Frx13Cm Split Seamless Hemostat Vlv Robust Sidept W/Gw Dilator","code_information":[{"code":"7718931","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill 3.5X140Mm Cannul Ao Coupl","code_information":[{"code":"7718932","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Instrument Endo Cufftack Easy Out","code_information":[{"code":"7718933","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":1117.0,"discounted_cash":446.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext P.F.C Sigma 13X30Mm Cement Modul Flute Rotat Hinge Cocr Knee Strl","code_information":[{"code":"7718934","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2174.0,"discounted_cash":869.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur P.F.C Sigma Tc3 Size 3 61/66Mm Cement Post Stabil C/S Revis Cocr Non-Porous Rt","code_information":[{"code":"7718935","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14942.0,"discounted_cash":5976.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 3 66Mm/42Mm 10Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7718936","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4215.0,"discounted_cash":1686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill A.L.P.S Twist 2.9X70Mm Quick-Coupling Solid Scp","code_information":[{"code":"7718937","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Tubing Ext Pump 60In 0.57Ml Priming Microbore Fixed Male Ll Dehp-Free","code_information":[{"code":"7718938","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tray Component Tibial Lcs Complete Size 2 Cement Stemmed Post Stabil Keeled Tricompart Mobile","code_information":[{"code":"7718939","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7516.0,"discounted_cash":3006.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Countersink Drill 3Mm/4Mm Cannul Shaft End S-Couple","code_information":[{"code":"7718940","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Instrument Ortho Easy Out-Screw Removal","code_information":[{"code":"7718941","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":334.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Extern Fixat Traction 3X75Mm 28Mm Thread Cove Point Ti","code_information":[{"code":"7718942","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 3X30Mm 8Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7718943","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg 4X30Mm 8Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7718944","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Urology Proc Heyman 12-18Fr W/10Ml Glove Syringe Cath Lubricant Pvp-I Solution Rayon Prep Ball","code_information":[{"code":"7718945","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":282.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Balloon,Pta 14X40X80 417-1440S Maxi Balloon - 7 Fr","code_information":[{"code":"7718946","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1477.0,"discounted_cash":590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Lg 10Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7718947","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 9.2X109Mm 10-Hole 1.3Mm 100Deg Angle Tubul Lck Timax Anatomic Lat Malleolar Dist","code_information":[{"code":"7718948","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 4X38Mm 8Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7718949","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bur,4X38 Rd Fine Diamond E6140","code_information":[{"code":"7718950","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bur,1X48 Round Steel     E8210","code_information":[{"code":"7718951","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bur,2X48 Round Steel     E8220","code_information":[{"code":"7718952","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 1X48Mm Spinal Round Fine 200-230-Grit E9000 Diamond Strl F/Otology Neuro","code_information":[{"code":"7718953","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 2X48Mm Spinal Round Fine 140-170-Grit E9000 Diamond Strl F/Otology Neuro","code_information":[{"code":"7718954","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill A.L.P.S 3.5X70Mm S-Couple Solid","code_information":[{"code":"7718955","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 78Mm 6-Hole Std Active Compress Ti Ant Clavicle F/3.5Mm Screw","code_information":[{"code":"7718956","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Instrument Ortho A.L.P.S Easy Out S-Couple","code_information":[{"code":"7718957","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":303.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Amplatz Super Stiff Exchange Specialty 0.035Inx260Cm 7Cm Tip Strt Taper Lg Core Soft","code_information":[{"code":"7718958","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Splashwire 0.035Inx260Cm 3Cm Angle Tip Fixed Core Stiff Exchange Steer Hydrphil","code_information":[{"code":"7718959","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Chest Tube Lf Disp Insert 17100","code_information":[{"code":"7718960","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Autotransfusion Symphony Std Manifold Platelet Chamber W/Plunger Forceps Syringex2 Ns F/Graft","code_information":[{"code":"7718961","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Nerve Block Sgl Shot Stimuplex Ultra 360 22Ga 3 1/8In 30Deg Bevel Tip Stimulating Echo Insul","code_information":[{"code":"7718962","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone A.L.P.S 3.5X24Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718963","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X26Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718964","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X30Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X20Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7718966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":220.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X36Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X42Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Std 12.5Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7718969","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3793.0,"discounted_cash":1517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 4X48Mm Spinal Round Fine 100-120-Grit E9000 Diamond Strl F/Otology Neuro","code_information":[{"code":"7718970","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Pe.R.I Sm Non-Locking Timax Calcaneal F/Fragment Frx Ns","code_information":[{"code":"7718971","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1233.0,"discounted_cash":493.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X16Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X18Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X22Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718974","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Mpa2 2Sh 3-Stage Braid Thrulumen Soft Tip","code_information":[{"code":"7718975","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective Williams 5Frx100Cm 3Drc 3-Stage Braid Thrulumen Soft Tip","code_information":[{"code":"7718976","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Jr4 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7718977","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Jl4 6-Sh 3-Stage Braid Thrulumen Soft Tip","code_information":[{"code":"7718978","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Connector, Ureteral    3365-00","code_information":[{"code":"7718979","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak Plus 60Mm Cannul Compress Headless Ti Hex Drive Strl","code_information":[{"code":"7718980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 1.1Mm Kirschner Temp","code_information":[{"code":"7718981","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7718982","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Tibial Nexgen Size 5 74/46Mm Stemmed Plate C/R Tivanium Pmma Uhmwpe Precoat Lt Rt Knee","code_information":[{"code":"7718983","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6836.0,"discounted_cash":2734.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Nexgen 32Mm Std 8.5Mm Onset All Pe Strl","code_information":[{"code":"7718984","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":1057.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7718985","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2936.0,"discounted_cash":1174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Humeral Bigliani/Flatow 46Mm Offst 17Mm Modul Zimaloy","code_information":[{"code":"7718986","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4727.0,"discounted_cash":1890.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Lcs Complete Standard+ Cementls C/R Tricompart Cocr Porocoat Rt White Gray","code_information":[{"code":"7718987","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11564.0,"discounted_cash":4625.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Standard+ 12.5Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7718988","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3793.0,"discounted_cash":1517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Lg 12.5Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7718989","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Lcs Complete Lg Cementls C/R Tricompart Cocr Porocoat Lt White Gray","code_information":[{"code":"7718990","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11564.0,"discounted_cash":4625.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Smartnail 1.5X16Mm Round Flat Head Arthro Lo-Pro Absorb 96L/4D Plla Polymer F/Ocd Soft","code_information":[{"code":"7718991","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Large+ 12.5Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7718992","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheath,Holmium Fiber    G15195 2 Fr For 200 Mircon Fiber Cat","code_information":[{"code":"7718993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X14Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X28Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X12Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Dural Duragen Classic 1X3In Regeneration Absorb Ultrapure Resorb Porous Type I Collagen Matrix","code_information":[{"code":"7718997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1132.0,"discounted_cash":452.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Lcs Complete Standard+ 10Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7718998","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X10Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7718999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X20Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak Plus 4Mm Cannul","code_information":[{"code":"7719001","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw,55Mm Fixation  Ap-0055-S Acutrak Plus","code_information":[{"code":"7719002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X32Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X34Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X38Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X40Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X44Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X30Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X36Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X46Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X50Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X35Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X40Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X45Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X50Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X55Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Coaxial Intro","code_information":[{"code":"7719017","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Extern Fixat 11X250Mm Conn Dist Radial Carbon Fiber F/Large Fixator System Ns","code_information":[{"code":"7719018","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 11X350Mm Conn Dist Radial Carbon Fiber F/Large Fixator System Ns","code_information":[{"code":"7719019","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 11X400Mm Conn Dist Radial Carbon Fiber F/Large Fixator System Ns","code_information":[{"code":"7719020","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Extern Fixat Schanz 5Mm Lg 175Mm 60Mm Thread Self-Drill Blunt Trocar Point Chondral Hip Femur","code_information":[{"code":"7719021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":213.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sheath Urological Flexor Access 12Frx20Cm Ureteral Taper Tip W/Dilat Aq Hydrphil Strl Disp","code_information":[{"code":"7719022","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sheath Urological Flexor Access 12Frx35Cm Ureteral Taper Tip W/Dilator Aq Hydrphil Strl Disp","code_information":[{"code":"7719023","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Tibial Repicci Ii 32Mm 6.5Mm Cement Unicompart Uhmwpe Lt Rt Knee Strl","code_information":[{"code":"7719025","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3191.0,"discounted_cash":1276.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sling Gyn Gynecare Tvt 1.1X45Cm Pp Mech Cut Vag Blue W/Nonabsorbable 2-Needle Urethra Reinforce","code_information":[{"code":"7719026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2631","type":"HCPCS"}],"standard_charges":[{"gross_charge":3280.0,"discounted_cash":1312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone 38X45Mm 0.4Mm Strt Contour Mesh Ti F/1.3Mm Screw Cranfac Ns","code_information":[{"code":"7719027","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3891.0,"discounted_cash":1556.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 28Mm +5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7719028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2454.0,"discounted_cash":981.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Acutrak 45Mm   Ap-0045-S Plus Fixation Screw","code_information":[{"code":"7719029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak Plus 50Mm Cannul Compress Headless Ti Hex Drive Strl","code_information":[{"code":"7719030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw,65.0Mm Acutrak Ap-0065-S Plus Fixation Screw","code_information":[{"code":"7719031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak Plus 70Mm Cannul Compress Headless Ti Hex Drive Strl","code_information":[{"code":"7719032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw,75.0Mm Acutrak Ap-0075-S Plus Fixation Screw","code_information":[{"code":"7719033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1X44.5Mm Maxillofacial J-Latch Coupl W/6Mm Stop Ss Ns","code_information":[{"code":"7719036","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Electrode Electrosurgical Cautery 2.75In Tip Needle Modif Insul Extend Ptfe Coat Ltx","code_information":[{"code":"7719037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Half Pin Extern Fixat 4X90Mm C-Shaped 40Mm Thread Self-Tapping/Drilling Modif Cont Apex Ss Ns","code_information":[{"code":"7719039","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat Adjust Hoffmann Ii Ss F/4/5/6Mm Pin Pvc-Free Mri-Safe","code_information":[{"code":"7719040","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":906.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X18Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Cath Brite Tip Sheath 8Fr Taper Dual Layer Slix Manicured Atraum W/Mini-Wire 35Mm Dilator","code_information":[{"code":"7719042","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Graft Vasc Vectra 6Mmx50Cm 1Mm Speciality Strt Slf-Seal 3Layer Eptfe Periph Artery","code_information":[{"code":"7719043","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4908.0,"discounted_cash":1963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X53Mm Bipol Modul Cup Ball Cocr Hip Blue","code_information":[{"code":"7719044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3369.0,"discounted_cash":1347.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx110Cm Strt Pig 6Sh 3-Stage Braid Thrulumen Soft Tip","code_information":[{"code":"7719045","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Uhr 28X52Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7719046","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4014.0,"discounted_cash":1605.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Storq Guidewire 300Cm 503-356Y Angled .035","code_information":[{"code":"7719047","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Endoloop Vicryl #0 18In Ties Violet Ej10G Endo Coat Braid Polyglactin 910 W/O Needle Absorb","code_information":[{"code":"7719048","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X12Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X14Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Omega Plus 2.8Mm 230Mm Thread Chuck Fit Tip Cocr Strl","code_information":[{"code":"7719051","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 4X4Mm","code_information":[{"code":"7719052","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 6X6Mm","code_information":[{"code":"7719053","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":330.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 8X8Mm","code_information":[{"code":"7719054","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":867.0,"discounted_cash":346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Electrosurgical Ligasure Xtd 2.8Cm Curve Jaw Hand/Footswitch Snap-In Cord Lf Strl Disp","code_information":[{"code":"7719055","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Spinal Pencan 22Ga 3 1/2In Pencil Point Plastic Hub Lf Dehp-Free Bpa Strl P2235","code_information":[{"code":"7719056","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Hip Compo Omega Plus 13X90Mm Compress Lag 22Mm Thread Std Ss Strl","code_information":[{"code":"7719057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":322.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1.5Mm Mini 65Mm Maxillofacial Quick-Coupling Ss Ns F/Lcp Screw Fixat","code_information":[{"code":"7719059","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X12Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Radial Hand F/Modular Ns","code_information":[{"code":"7719060","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X48Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7719061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sealer Lap Ligasure Atlas Divider 10Mmx37Cm 22Mm Cut 22Mm Seal Strt Blunt Jaw 359Deg Rotat Hand/Foot","code_information":[{"code":"7719062","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1632.0,"discounted_cash":652.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 58Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7719063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5459.0,"discounted_cash":2183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Pinnacle 60Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7719064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5459.0,"discounted_cash":2183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Patellar Nexgen 29Mm Std 8Mm Onset All Pe Strl","code_information":[{"code":"7719065","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2643.0,"discounted_cash":1057.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Nexgen Size 3 66/42Mm Stemmed Plate C/R Tivanium Pmma Uhmwpe Precoat Lt Rt Knee","code_information":[{"code":"7719066","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7451.0,"discounted_cash":2980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/3-4 Std 66Mm/42Mm 10Mm Net Shape Lt Rt Knee Artic Surface Post","code_information":[{"code":"7719067","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4647.0,"discounted_cash":1858.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial Lcs Complete Size 6 Cement Stemmed Post Stabil Keeled Tricompart Mobile","code_information":[{"code":"7719068","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7516.0,"discounted_cash":3006.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Applicator Platelet Concentrat Liquid W/Dual Lumen 2Inl Tipx1 1Mml Syringex1 10Ml Harvest Prp","code_information":[{"code":"7719069","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Applicator Spray Symphony Sk/2","code_information":[{"code":"7719070","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X30Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Biostop Restrictor 5463-12-000","code_information":[{"code":"7719072","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +1.5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7719073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2936.0,"discounted_cash":1174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle Ultamet 36X54Mm Neutral Cocr Metal","code_information":[{"code":"7719074","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5971.0,"discounted_cash":2388.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Glidewire 0.035Inx180Cm 3Cm Tip Angle Flex Std Stiff Shaft Nitinol Hydrphil Tungsten","code_information":[{"code":"7719075","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone A.L.P.S 4X42Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupling Extern Fixat Size +5X8Mm/4Mm Pin To Rod Inverted Hoffmann Ii Ss F/Foot Ankle System","code_information":[{"code":"7719077","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1518.0,"discounted_cash":607.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupling Extern Fixat Lg Rod-Rod Multi-Pin Adjust Hoffmann Ii Ss F/8Mm Rod/Post Pvc-Free","code_information":[{"code":"7719078","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2143.0,"discounted_cash":857.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X10Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X20Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 9X57Mm 5-Hole 1Mm 1/3 Tubul Contour Compress Lck Ss Limit-Cont Dist Fibula","code_information":[{"code":"7719081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilator Vasc Std 8Frx20Cm Lf Strl Disp 0.038In Gw","code_information":[{"code":"7719082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Trigen 11.5X300Mm Cannul Antegrade/Retrograde Femur Tibial Ti Alloy Gold","code_information":[{"code":"7719083","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5753.0,"discounted_cash":2301.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 65Mm 5-Hole Std Active Compress Ti Ant Clavicle F/3.5Mm Screw","code_information":[{"code":"7719084","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft.Vascular          Ag-740 Artegraft Collagen","code_information":[{"code":"7719085","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3723.0,"discounted_cash":1489.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Nut             03756230","code_information":[{"code":"7719086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Hemostar      5835150 14.5Fr - 19Cm Long - Curved","code_information":[{"code":"7719087","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":493.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Med 146Mm Semi-Circular Curve Conn Hoffmann Ii Compact Ss","code_information":[{"code":"7719088","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Eon Size 8 11.3Mm Dist 42X135Mm Cement Std Offst Cocr 132Deg Angle Taper 35Mm","code_information":[{"code":"7719089","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11750.0,"discounted_cash":4700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Pds Ii #1 96In 1/2 Circ Tp-1 Taper Point Loop Violet 1 Strand/Pk Z880G Uni-Direct Monofil","code_information":[{"code":"7719090","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Half Pin Extern Fixat 4X150Mm C-Shaped 50Mm Thread Self-Tapping/Drilling Modif Cont Apex Ss Ns","code_information":[{"code":"7719091","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 45Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719092","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stone Cone 10Mm    M0063903200","code_information":[{"code":"7719094","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drain Yueh Centesis 5Frx7Cm Strt 4Sp Pig Loop 5-Lumen W/19Ga Hollow Needle Ss Nylon","code_information":[{"code":"7719095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Drain Yueh Centesis 5Frx10Cm Strt 4Sp Pig Loop 5-Lumen W/19Ga Hollow Needle Ss Nylon","code_information":[{"code":"7719096","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guiderod Ortho Trigen 3Mm 1000Mm Ball Tip Ss F/Intramedullary Nail Strl Disp","code_information":[{"code":"7719097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":274.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Tubing Ext Cadd 90In 2.4Ml Priming Port Inject Site 0.2Um Filter Male Ll Integral Anti-Siphon","code_information":[{"code":"7719098","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Proc 18Ga 9Cm 1-Part Entry Thin-Wall Percutan Vasc No Baseplate Ss Stylet 0.035/0.038In Gw","code_information":[{"code":"7719099","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill 1.8X125Mm Maxillofacial J-Latch Coupl Cannul Gold Ss Ns F/Screw Fixat Lcp","code_information":[{"code":"7719100","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X32Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur 28Mm 2.5Mm Offst C-Tapered Primary Modul Anatomic Low Friction Ion Treatment Cocr Hip","code_information":[{"code":"7719102","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3953.0,"discounted_cash":1581.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Instruments,Pacemaker                     San23Indca","code_information":[{"code":"7719103","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Pacemaker Cardiac San23Pmcaa","code_information":[{"code":"7719104","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X55Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7719105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X65Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7719106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X70Mm Cannul Fully/Double Lead Thread Self-Drilling/Tapping Cortic Timax Blunt Tip","code_information":[{"code":"7719107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm -2Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7719108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2936.0,"discounted_cash":1174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone A.L.P.S 4X30Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Airway Laryngeal Lma Unique Mask Size 5 Adult Cuffed Aperture Bar Pilot Silicone Pvc Tube Lf","code_information":[{"code":"7719110","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/3-4 Std 66Mm/42Mm 10Mm Net Shape Lt Rt Knee Artic Surface Post","code_information":[{"code":"7719111","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5014.0,"discounted_cash":2005.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size H 76.5/70.5Mm Cement Post Stabil Zimaloy Pmma Rt Striped Green","code_information":[{"code":"7719112","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12271.0,"discounted_cash":4908.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Nexgen Size 7 89/57Mm Stemmed C/R Tivanium Pmma Uhmwpe Precoat Lt Rt Knee Blue Strl","code_information":[{"code":"7719113","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7451.0,"discounted_cash":2980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 8X250Mm Conn Hoffmann Ii Yellow Carbon Fiber Mri-Safe 5029-8-825","code_information":[{"code":"7719114","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Reflexion Sm Base Phalangeal","code_information":[{"code":"7719115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3921.0,"discounted_cash":1568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Reflexion Std Headed Metatarsal","code_information":[{"code":"7719116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1724.0,"discounted_cash":689.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 4X120Mm C-Shaped 35Mm Thread Self-Tapping/Drilling Apex Ss F/Thr Ns","code_information":[{"code":"7719117","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":150.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Extern Fixat 5/4X250Mm 40Mm Thread Self-Tapping/Drilling Transfixing Hoffmann Ii Apex Ss","code_information":[{"code":"7719118","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 5X150Mm C-Shaped 40Mm Thread Self-Tapping/Drilling Apex Ss F/Thr Ns","code_information":[{"code":"7719119","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Hoffmann Iii 3.2X200Mm Jacobs Chuck End Point Tip Gray F/4Mm Apex Half Pin","code_information":[{"code":"7719120","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":158.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5X155/180Mm Maxillofacial 2-Flute Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns Disp","code_information":[{"code":"7719121","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lc-Dcp 3.5X55Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Dist","code_information":[{"code":"7719122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Post Extern Fixat 5Mm Short 120Mm 30Deg Angle Strt Multi-Planar Coupl Pin To Rod Hoffmann Ii Compact","code_information":[{"code":"7719123","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ace 2X12Mm Twist-Off","code_information":[{"code":"7719124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.0,"discounted_cash":302.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X34Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X36Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":266.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screwdriver Surg 6.5Mm Hex Quick-Coupling","code_information":[{"code":"7719128","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Trigen Meta-Nail Pilot 4Mm Short 6In Qck-Conn Strl Disp F/Intramedullary Screw","code_information":[{"code":"7719129","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Intro Repositioning 9Fr Sm 60Cm Press-Fit Swan-Ganz Pacing Cath-Lock Ll Adapt Hemostat Vlv","code_information":[{"code":"7719130","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Extern Fixat 8X220Mm Conn Dist Radial Carbon Fiber F/Medium Fixator System Ns","code_information":[{"code":"7719131","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X56Mm +4 10Deg Angle Lat Marathon","code_information":[{"code":"7719132","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4564.0,"discounted_cash":1825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 36Mm +8.5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7719133","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 43Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719134","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 22Mm 8-Hole H-Shaped Compress Lck Ti Extend Rt Condylar F/1.5Mm Screw Ns","code_information":[{"code":"7719135","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":246.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 3/8-Hole Y-Shaped Contour Compress Lck Ti Condylar F/1.5Mm Screw Ns","code_information":[{"code":"7719136","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 36Mm 7-Hole Compress Lck Ti Lt Condylar F/1.5Mm Screw Ns","code_information":[{"code":"7719137","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":309.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 3.5X36Mm 7-Hole Compress Lck Ti Rt Condylar F/1.5Mm Screw Ns","code_information":[{"code":"7719138","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":309.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 23Mm 6-Hole Strt Compress Lck Ti Hand Smh F/1.3Mm Screw Ns","code_information":[{"code":"7719139","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 47Mm 12-Hole Strt Compress Lck Ti Hand Smh F/1.3Mm Screw Ns","code_information":[{"code":"7719140","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 15Mm 8-Hole H-Shaped Compress Lck Ti Extend Rt Hand F/1.3Mm Screw Ns","code_information":[{"code":"7719141","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":246.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 15Mm 8-Hole H-Shaped Compress Lck Ti Extend Lt Hand F/1.3Mm Screw Ns","code_information":[{"code":"7719142","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":246.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 32Mm 3/8-Hole Y-Shaped Compress Lck Ti Hand F/1.3Mm Screw Ns","code_information":[{"code":"7719143","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":237.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X8Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Radial Hand F/Modular Mini","code_information":[{"code":"7719144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X16Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Radial Hand F/Modular Ns","code_information":[{"code":"7719145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 3.8X29Mm 6-Hole 0.8Mm Mini Strt Compress Lck Ti F/1.5Mm Screw Ns","code_information":[{"code":"7719146","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 3.8X59Mm 12-Hole 0.8Mm Mini Strt Compress Lck Ti F/1.5Mm Screw Ns","code_information":[{"code":"7719147","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 4X44Mm 3/8-Hole 1Mm T-Shaped Compress Lck Ti F/1.5Mm Screw Ns","code_information":[{"code":"7719148","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":237.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 40Mm 4/8-Hole T-Shaped Compress Lck Ti F/1.5Mm Screw Ns","code_information":[{"code":"7719149","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":246.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 22Mm 8-Hole H-Shaped Compress Lck Ti Extend Lt Condylar F/1.5Mm Screw Ns","code_information":[{"code":"7719150","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":246.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 63Mm 8-Hole Mini Dynamic Compress Lck Ti F/2.4Mm Screw Ns","code_information":[{"code":"7719151","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1055.0,"discounted_cash":422.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2X16Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Radial Hand F/Modular Mini","code_information":[{"code":"7719152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":97.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 39Mm 7-Hole Compress Lck Ti Lt Condylar F/2Mm Screw Ns","code_information":[{"code":"7719153","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":309.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 39Mm 7-Hole Compress Lck Ti Rt Condylar F/2Mm Screw Ns","code_information":[{"code":"7719154","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":309.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat 1.8X18Mm Perm Buttress Ti Dist Radial Ns","code_information":[{"code":"7719155","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 35Mm 6-Hole Mini Strt Compress Lck Ti Hand F/2Mm Screw Ns","code_information":[{"code":"7719156","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 71Mm 12-Hole Mini Strt Compress Lck Ti Hand F/2Mm Screw Ns","code_information":[{"code":"7719157","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 48Mm 3/8-Hole Mini Y-Shaped Compress Lck Ti Hand F/2Mm Screw Ns","code_information":[{"code":"7719158","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 36Mm 6-Hole Mini Dynamic Compress Lck Ti Condylar F/2Mm Screw Ns","code_information":[{"code":"7719159","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":401.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X20Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4/4.5X10Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Gold Radial Hand","code_information":[{"code":"7719161","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4/4.5X12Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Gold Radial Hand","code_information":[{"code":"7719162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4/4.5X14Mm Full Thread Self-Tap Cortic Ti Cruciform Recess Gold Radial Hand","code_information":[{"code":"7719163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Matrix Bone Graft Accell 100 10Ml","code_information":[{"code":"7719164","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5775.0,"discounted_cash":2310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 4/2.5X80Mm 20Mm Thread Self-Drill Blunt Trocar Point Chondral Hip Femur","code_information":[{"code":"7719165","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Lcp 2.5Mm 200Mm Drill Tip Ss F/Periprosthetic Femur Plate Ns","code_information":[{"code":"7719166","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Lcp 118Mm 6-Hole Pre-Contoured Compress Lck Ss Lt Prox Tibial F/4.5Mm Screw Ns","code_information":[{"code":"7719167","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5141.0,"discounted_cash":2056.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X70Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex Ns","code_information":[{"code":"7719168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4.3X200Mm Maxillofacial Cannul Quick-Coupling Ss Ns F/5Mm Lcp Screw Fixat","code_information":[{"code":"7719169","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":409.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Articul/Eze 36Mm +12Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7719170","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Spectrum Siltex 15-14.5Cm X 12.7-12.5Cm 6.6-8.2Cm Contour-Profile 650-780Ml","code_information":[{"code":"7719171","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4682.0,"discounted_cash":1872.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Spectrum Siltex 13.7X11.9Cm 7.9Cm Contour-Profile 550-660Ml Saline-Filled Texture","code_information":[{"code":"7719172","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4682.0,"discounted_cash":1872.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Bigliani/Flatow 46Mm Offst 21Mm Modul Zimaloy","code_information":[{"code":"7719173","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5035.0,"discounted_cash":2014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Cann Dense Bone  At-7032","code_information":[{"code":"7719174","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":295.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Prodigy Long 15X160Mm Cementls Collar Lg Stature Porous 12/14 Taper Rt Hip","code_information":[{"code":"7719175","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15042.0,"discounted_cash":6016.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 5Mm Lg 200Mm 50Mm Thread Self-Tap Blunt Trocar Point Chondral Hip Femur","code_information":[{"code":"7719176","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3.5X195Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns F/Lcp Screw","code_information":[{"code":"7719177","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Ortho Atn 3Mm 28In Driving Humeral Strl Disp","code_information":[{"code":"7719178","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Versanail Twist 4.4Mm Calib","code_information":[{"code":"7719179","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 3.8Mm Qck-Conn Calib","code_information":[{"code":"7719180","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reamer Surg Versanail Entry Drill 8.5Mm Cannul","code_information":[{"code":"7719181","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 1.6X150Mm Kirschner Temp 5Mm Thread Trocar Point Ss Ns","code_information":[{"code":"7719182","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 90Mm 6/3-Hole Short Pre-Contoured Compress Lck Ss Std Lt Prox Humeral Shaft F/3.5Mm","code_information":[{"code":"7719183","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5328.0,"discounted_cash":2131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cath Balloon Mega 50Cc 8.0 Fr 0684-00-029601U","code_information":[{"code":"7719184","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3654.0,"discounted_cash":1461.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cath Balloon Mega 40Cc 7.5Fr                  068400029501U","code_information":[{"code":"7719185","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3654.0,"discounted_cash":1461.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X16Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7719186","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X14Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7719187","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1.8X100Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns F/Lcp Screw","code_information":[{"code":"7719188","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.4X100Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns F/Lcp Screw","code_information":[{"code":"7719189","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit,Gelport              Ck628","code_information":[{"code":"7719190","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2570.0,"discounted_cash":1028.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X45Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X40Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X28Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719193","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X24Mm Russell-Taylor Lck Full Thread","code_information":[{"code":"7719194","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 4.8Mm F/Orthopedic","code_information":[{"code":"7719195","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X50Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X55Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719197","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Post Extern Fixat 8Mm Strt Hoffmann Ii Ss","code_information":[{"code":"7719198","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 28Mm +1.5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7719199","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2453.0,"discounted_cash":981.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Press Monitor Thermoset Iced Cold Injectate Rt Closed Loop Icu Output W/In-Line Thermistor","code_information":[{"code":"7719200","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dilator Vasc Std 10Frx20Cm Lf Strl Disp 0.038In Gw","code_information":[{"code":"7719201","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dilator Vasc Std 7Frx20Cm Lf Strl Disp 0.038In Gw","code_information":[{"code":"7719202","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Trigen 6.4X85Mm Self-Drilling/Tapping Captured Cortic Ti Blue Im Reconstruct","code_information":[{"code":"7719203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":420.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 6.4X100Mm Self-Drilling/Tapping Captured Cortic Ti Blue Im Reconstruct","code_information":[{"code":"7719204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.0,"discounted_cash":442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 53Mm Head Std 190Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719205","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X30Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X32Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X34Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X38Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X120Mm 135Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7719210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Cover Probe Sheath Ultrasound Transducer Site-Rite A 6X48In Endocavity Pre-Folded 2-Elastic","code_information":[{"code":"7719211","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X36Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X40Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7719213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Drill 2.8Mm Thread Ns F/3.5Mm Lck Screw","code_information":[{"code":"7719214","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Matrix 1X44.5Mm 8Mm Stop Maxillofacial J-Latch Coupl Ss Ns F/Modular Hand System Lcp","code_information":[{"code":"7719215","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Lcp 1.5X75Mm Maxillofacial J-Latch Quick-Coupling Jacobs Chuck End Gold Ss Ns F/1.5/2Mm","code_information":[{"code":"7719216","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Lcp 1.1X65Mm Maxillofacial J-Latch Quick-Coupling Ss Ns F/1.5/2Mm Plate","code_information":[{"code":"7719217","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho T2 3Mm 800Mm Ball Tip Ti Femur F/Intramedullary Nailing System Strl Gam","code_information":[{"code":"7719218","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat T2 3X285Mm Kirschner Temp Quick-Coupling Cocr Strl F/Intramedullary Nailing System","code_information":[{"code":"7719219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Sling Gyn Lynx Pp Pubovaginal Mid-Urethral Suprapubic W/Nonabsorbable Curve Ndl Urethra","code_information":[{"code":"7719220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2631","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.0,"discounted_cash":1339.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Omnifit Eon Size 7 10.4Mm Dist 41X130Mm Cement Std Offst Cocr 132Deg Angle Taper 35Mm","code_information":[{"code":"7719221","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12469.0,"discounted_cash":4987.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Versanail 12Mm Univ 200Mm Cannul Lck Tibiotalocalcaneal Ankle Ti Alloy Strl","code_information":[{"code":"7719222","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6355.0,"discounted_cash":2542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versanail 5.5X85Mm Lck Full Thread Solid Cortic Ti Prox Im Ns","code_information":[{"code":"7719223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Forceps Spec Retriev Jawz Biopsy 7Frx105Cm 2.2Mm Jaw Endomyocardial Strt Formable Ss","code_information":[{"code":"7719224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":536.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X46Mm Full Thread Dbl Lead Self-Drilling/Tapping Cortic Timax Prox Femur","code_information":[{"code":"7719225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X40Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Joint Instrument 1/8In Knee Headless","code_information":[{"code":"7719227","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1954.0,"discounted_cash":781.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pad Defib Quik-Combo Lifepak 12 Electrode 4X3.5In 24In Leadwire Ped Pace Conn Redi-Pak Preconnect","code_information":[{"code":"7719228","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tap Surg 6.5Mm F/Screw Washer","code_information":[{"code":"7719229","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1010.0,"discounted_cash":404.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Eius Lg Unicompart Rt Medial Lt Lat","code_information":[{"code":"7719230","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11118.0,"discounted_cash":4447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Eius Lg 8Mm Unicompart Rt Medial Lt Lat","code_information":[{"code":"7719231","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7584.0,"discounted_cash":3033.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X54Mm +4 10Deg Angle Lat Marathon","code_information":[{"code":"7719232","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4564.0,"discounted_cash":1825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Kyphoplasty Kyphopak Additional Frx W/Size 3 15Mm 2-Kyphon Xpander Ii Ibt 6-Bone Filler/Tamp","code_information":[{"code":"7719234","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10371.0,"discounted_cash":4148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur G7 32Mm +3Mm Neck Compo Type 1 Taper Modul Non-Skirted Dual Mobility Construct Cocr Hip","code_information":[{"code":"7719235","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X24Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Atlantis 4X13Mm Self-Drill Var Ang Cancell Ti Ant Cervical Ns","code_information":[{"code":"7719237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Restrictor,Cement  5463-10-000 Biostop Sz 10","code_information":[{"code":"7719238","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Ekg Quadtrode Resting Std Hydrogel Color-Cd Foam F/Mri Lf Strl Disp","code_information":[{"code":"7719239","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Humeral Global Advantage 44X15Mm Cocr","code_information":[{"code":"7719240","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5375.0,"discounted_cash":2150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Moreland Blade 6Mm Thin Short 1.5In Knee U-Shaped Flex F/Cementless Revis","code_information":[{"code":"7719241","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Moreland Blade 6Mm Long 3In Knee U-Shaped Flex F/Cementless Revis","code_information":[{"code":"7719242","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Aml 13.5X165Mm Cementls Std Offst Collar Ti 5/8 Porocoat 135Deg Angle 12/14 Taper Hip","code_information":[{"code":"7719243","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14691.0,"discounted_cash":5876.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Pacing Nbih Bipol Temp 5Frx125Cm 1Cm Prox Lt Ventric W/2-Universal Adapt Lf","code_information":[{"code":"7719244","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Vasc Protege Everflex 8X40Mm 80Cm Slf-Expand Ss Common Ext Iliac Artery 0.035In Gw 6Fr Sheath","code_information":[{"code":"7719245","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4991.0,"discounted_cash":1996.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sealer Lap Ligasure Atlas Divider 10Mmx20Cm 20Mm Cut 22Mm Seal Strt Bilat Blunt 359Deg Rotat Hand","code_information":[{"code":"7719246","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1632.0,"discounted_cash":652.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 42Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719247","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 6.4X90Mm Self-Drilling/Tapping Captured Cortic Ti Blue Im Reconstruct","code_information":[{"code":"7719248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1065.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Non-Impinging Ti Im","code_information":[{"code":"7719249","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Particulate Bone Graft I/C Graft Chamber Allograft 10Ml Frz-Dry Osteobio Cancell Dbm","code_information":[{"code":"7719250","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2904.0,"discounted_cash":1161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Close Femostop Gold Plus Femur Artery W/Arch Pneumatic Dome Digi Manomet Adjust Belt Pinch","code_information":[{"code":"7719251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Ima Nsh 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7719252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade,Hall Surgical   5071-144","code_information":[{"code":"7719253","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X40Mm Bipol Modul Cup Ball Cocr Hip Rust","code_information":[{"code":"7719255","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3369.0,"discounted_cash":1347.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Biopince Ultra Express Auto Device 18Ga 10Cm Echo W/Triaxial Gun Intro F/Full Core","code_information":[{"code":"7719256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Cope Workhorse 0.018Inx60Cm 7Cm Tip 7.25Cm Taper Angle Soft Flex Spring Coiled Std","code_information":[{"code":"7719257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Introducer,Flexor 6Fr   G10383","code_information":[{"code":"7719258","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon,Opta Pro 8   419-8040S *8.0 X 40Mm 80Cm","code_information":[{"code":"7719259","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Gii Arthro 2.4Mm Mini F/Quick Anchor","code_information":[{"code":"7719260","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon, Power Flex  415-0040S Extreme 10 X 4 X 80","code_information":[{"code":"7719261","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":340.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X20Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7719263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X22Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7719264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X24Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7719265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":266.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X30Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7719266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Emerge 2.8Mm 300Mm Thread Trocar Point Tin Ns","code_information":[{"code":"7719267","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 7.3X45Mm Cannul Compress Lck 16Mm Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7719268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 5Mm Lg 300Mm 250Mm Maxillofacial 3-Flute Quick-Coupling Cannul Gold Ss Ns F/7.3Mm Lcp","code_information":[{"code":"7719269","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1533.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Opta Pro Dilatat Workhorse 9X20Mm 80Cm Otw 2Lumen F/Pta Lo-Pro Mod Press","code_information":[{"code":"7719270","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Lcs Complete Lg Cementls C/R Tricompart Cocr Porocoat Rt White Gray","code_information":[{"code":"7719271","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11564.0,"discounted_cash":4625.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Standard+ 17.5Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7719272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Glidecath 5Frx100Cm 25Cm/40Cm Jb1 Sgl Braid Lg Lumen Small-Profile Periph","code_information":[{"code":"7719274","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade,Hall Surgical   5071-123","code_information":[{"code":"7719275","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Exchange Workhorse 0.035Inx180Cm 1.5Cm Tip 4.5Cm Taper 1.5Mm Safe-T-J Rosen Fixed","code_information":[{"code":"7719276","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 5X200Mm Maxillofacial Cannul Quick-Coupling Gold Ss Ns F/Lcp Asif","code_information":[{"code":"7719277","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":421.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X50Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X42Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719279","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X18Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7719280","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Nexgen Size 2 62/41Mm Stemmed C/R Tivanium Pmma Uhmwpe Precoat Lt Rt Knee Yellow","code_information":[{"code":"7719281","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8185.0,"discounted_cash":3274.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Epidural Tuohy Perifix 17Ga 6In Bevel Tip Wing Depth Mark Ridge Clear Hub Lf Dehp-Free","code_information":[{"code":"7719282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Circuit Ext Anesth 30-90In Expand Lf","code_information":[{"code":"7719283","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3X21Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719284","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade,Oscillat Short  5023-170","code_information":[{"code":"7719285","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Autotransfusion Pvc Trocar Tubing Retention Vlv Unique Fat W/3/16In Dia Constavac Cbcii","code_information":[{"code":"7719286","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Matrix,Dural Graft     Id-1101 Duragen 1 X 1","code_information":[{"code":"7719287","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Xia Ii 5.5X40Mm Open Polyaxial Cort/Canc Pedicle Ti 60Deg Blue 50Deg Angle Top","code_information":[{"code":"7719288","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle Ultamet 36X52Mm Neutral Cocr Metal","code_information":[{"code":"7719289","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5971.0,"discounted_cash":2388.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Reflexion Long Headed Metatarsal","code_information":[{"code":"7719290","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1724.0,"discounted_cash":689.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Arthro 6X75Mm Integrate Flow Thread Rigid Dual-Seal Control Vlv Conical Tip W/Obturator","code_information":[{"code":"7719291","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Arthro 8.4X75Mm Integrate Flow Thread Rigid Dual-Seal Control Vlv Conical Tip W/Disp","code_information":[{"code":"7719292","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Arthro 8.4X90Mm Integrate Flow Thread Rigid Dual-Seal Control Vlv Conical Tip W/Disp","code_information":[{"code":"7719293","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Ace 3.2Mm 17 1/2In Thread Prox Lock F/Trochlear Nail System Disp - D","code_information":[{"code":"7719294","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X26Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719295","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw,3.5 Cortical 65Mm                     2347-20-70","code_information":[{"code":"7719296","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 32Mm +0Mm Neck 12/14 Taper Primary Endoprosthesis Cocr Hip Strl","code_information":[{"code":"7719297","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2769.0,"discounted_cash":1107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 32Mm +3.5Mm Neck 12/14 Taper Primary Endoprosthesis Cocr Hip Strl","code_information":[{"code":"7719298","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2769.0,"discounted_cash":1107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Insufflat Insuflow Gas Conditioning Tubing W/10Ml Ll Syringe F/Humidification System","code_information":[{"code":"7719299","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":164.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Endos 54Mm Head Std 190Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719300","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Electrosurgical Utahloop Lletz Leep 5Mm 25X22Mm 11Cm Shaft Round Loop Y-Shaped","code_information":[{"code":"7719301","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Mersilene 5Mmx12In 1/2 Circ Mo-4 Taper Point White 1 Strand/Pk Rs23 Uni-Direct Braid Pes 36Mm","code_information":[{"code":"7719302","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Biostop G Sz 14    5463-14-000","code_information":[{"code":"7719303","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 28Mm +8.5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7719304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2454.0,"discounted_cash":981.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Centralizer Stem Cementralizer 10Mm Pmma Dist Femur Hip Strl","code_information":[{"code":"7719305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 5 40X120Mm Cement Std Offst Collar Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7719306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15479.0,"discounted_cash":6191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acutrak 4/5 45Mm Cannul Headless Ti Hex Drive F/System Strl","code_information":[{"code":"7719307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":553.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw, Acutrak 4/5 Sys 40Mm                      Am-0040-S","code_information":[{"code":"7719308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":553.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Acutrak 0.054In Std 7In Thread Sgl Trocar Tip Ss F/K-Wire Screw Position Ns Disp","code_information":[{"code":"7719309","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 10-Hole Adjust Hoffmann Ii Ss F/4/5/6Mm Pin Pvc-Free","code_information":[{"code":"7719310","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3169.0,"discounted_cash":1267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill 2.8","code_information":[{"code":"7719311","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 3.5X65Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7719312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X58Mm +4 10Deg Angle Lat Marathon","code_information":[{"code":"7719313","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4564.0,"discounted_cash":1825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X40Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X42Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X46Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X85Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Trilogy 6.5X35Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cortic Strl","code_information":[{"code":"7719319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Trilogy 6.5X25Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cortic Strl","code_information":[{"code":"7719320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Dcp 2.7X12Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7719321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X10Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7719322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Peritoneal Dialysis Long-Term 15Frx57Cm Silicone Curl 2-Cuff Argyle","code_information":[{"code":"7719323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tray Picc San23Pccaa Line","code_information":[{"code":"7719324","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Tubing Ext Lifeshield 20In 2.7Ml Priming Macrobore Secure Lock M/F Adapt W/Slide Clamp Lf","code_information":[{"code":"7719325","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Balloon Pump Wire                0684-00-0254-09","code_information":[{"code":"7719326","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Sheath Bln Pump 8Frx15Cm Reinforc W/Hemostatis Vlv Dilator F/Sensation Plus 8Fr","code_information":[{"code":"7719327","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Matrix 1X60Mm Cmf J-Latch Coupl W/12Mm Stop Ss Ns F/Lcp Modul Hand System","code_information":[{"code":"7719328","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X16Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7719329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Handle Suction Via-Guard Andrews-Pynchon Ped Vasc Multi-Ported Flush-Fit Conn W/Poole Converter","code_information":[{"code":"7719330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Lcp 1.3X65Mm Maxillofacial J-Latch Coupl W/Stop Ss Ns F/Modular Hand System","code_information":[{"code":"7719331","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Cort 3.5X14Mm      Cs-14","code_information":[{"code":"7719332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dvr 3.5X16Mm Full Thread Cortic Ti Cruciform Head Magenta Dist Volar Radial F/Anatomic","code_information":[{"code":"7719333","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X24Mm Screw Non-Locking Perm Full Thread Self-Tap Ti Dist Radial Volar","code_information":[{"code":"7719334","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 2Mm Prox Volar Step Ss Strl Disp F/Fast Humerus Plate System","code_information":[{"code":"7719335","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit, Drill 2.5Mm        Db-2.5","code_information":[{"code":"7719336","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Tubing Admin Contrast 72In Lg Bore User-Selectable Vent Spike Strl Disp 25/Bx","code_information":[{"code":"7719337","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tray Catheter Thoracentesis Safety 5Frx7Cm Strt Vlv Slip Fit W/18/22/25 Ndl 10Ml/60Ml Syringe","code_information":[{"code":"7719338","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3X23Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719339","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X22Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":250.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drain Percuflex 8Frx25Cm Pig Loop All-Purp W/Trocar Metal Stiffen Cann Glidex Lf Strl Disp","code_information":[{"code":"7719341","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Catheter Thoracic 9Frx29Cm Tfe 20-Sideport W/18Ga/20Cm Needle Conn Tube Chest Drain Heimlich Vlv","code_information":[{"code":"7719342","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":214.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter, 4Fr 100Cm     G31016","code_information":[{"code":"7719343","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Royal Flush Plus 4Frx65Cm Vcf 8Sp Non-Braided High Flow Beacon Tip","code_information":[{"code":"7719344","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Lap Gelport Lg 120Mm Hand-Assist Portal W/Gelseal Cap Alexis Wound Ring Retractor Lubricant","code_information":[{"code":"7719345","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2350.0,"discounted_cash":940.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Versanail 5.5X30Mm Lck Full Thread Solid Cortic Ti Prox Im Ns","code_information":[{"code":"7719346","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sensor Neuro Bis Quatro 4-Electrode F/Anesthesia","code_information":[{"code":"7719347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pin Fixat Transfix Ii 5X50Mm Absorb Biocomposite Plla Acl Strl","code_information":[{"code":"7719348","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":493.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scissors Ophthal Sm Std 4.5In Strt Sharp Tip Iris Ss Lf Strl Floor Grd","code_information":[{"code":"7719349","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Dressing Neg Press Lg 15X25Cm Foam Lf W/1-Dressing 2-26Cm X 32Cm Clear Film Fit Pad Strl Disp","code_information":[{"code":"7719350","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone A.L.P.S 4X55Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719351","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 83Mm 6-Hole Buttress Ss Rt Lat Prox Tibial F/3.5/4Mm Cort/Canc Screw Strl","code_information":[{"code":"7719352","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2595.0,"discounted_cash":1038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Trilogy 6.5X30Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cortic Strl","code_information":[{"code":"7719353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 32Mm 50-54Mm Std 7.9Mm Neutral 0Deg Angle Full Hemis Primary Modul","code_information":[{"code":"7719354","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5159.0,"discounted_cash":2063.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cube Bone Graft Readigraft 1X1X1Cm Allograft Void Filler 20Ml Frz-Dry Cancell Ambient Store 5Yr","code_information":[{"code":"7719355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Siltex 13.2X13.8Cm 6.9Cm Contour-Profile 550Ml Silicone Gel Texture Bufferzone","code_information":[{"code":"7719356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5775.0,"discounted_cash":2310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extractor 6.5Mm F/6.5-8Mm Screw Disp","code_information":[{"code":"7719357","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hose Vacuum Aspirat Berkeley Safetouch Conn Suction 18In Assembly Bottle-To-Bottle Disp","code_information":[{"code":"7719358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Lcs Complete Standard+ Cement C/R Tricompart Cocr Rt White Gray","code_information":[{"code":"7719359","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8625.0,"discounted_cash":3450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 44Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719360","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chamber Graft Sm/5Cc   Gds005T","code_information":[{"code":"7719364","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":662.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Passer Suture Suturelasso Arthro 2.3Mm Shoulder 45Deg Rt Corkscrew Preload Rotator Cuff Stiff Shaft","code_information":[{"code":"7719365","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Pinnacle 6.5X25Mm Dome Self-Tap Polyaxial Gription Ti Foam Cancell Strl","code_information":[{"code":"7719366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Acetabular Pinnacle 6.5X35Mm Dome Self-Tap Polyaxial Gription Ti Foam Cancell Strl","code_information":[{"code":"7719367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Acetabular Pinnacle 6.5X20Mm Dome Self-Tap Polyaxial Gription Ti Foam Cancell Strl","code_information":[{"code":"7719368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Pinnacle 62Mm Multi-Hole Primary Sector Porocoat","code_information":[{"code":"7719369","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7800.0,"discounted_cash":3120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 48Mm Multi-Hole Primary Sector Porocoat","code_information":[{"code":"7719370","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7800.0,"discounted_cash":3120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Pinnacle 6.5X15Mm Dome Self-Tap Polyaxial Gription Ti Foam Cancell Strl","code_information":[{"code":"7719371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Passer Suture Suturelasso Sd Arthro 1.8Mm Shoulder Elbow 25Deg Tight Lt Curve Rotator Cuff Stiff","code_information":[{"code":"7719372","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Ekg Medi-Trace Lift Tab 1.43X1.65In Rect Conduct Adhes Hydrogel Fluid-Resistant Foam Adult","code_information":[{"code":"7719373","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Particulate Bone Graft I/C Graft Chamber Lg Allograft 15Ml Frz-Dry Osteobio Cancell Dbm","code_information":[{"code":"7719374","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5039.0,"discounted_cash":2015.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foley, Cath Tip Punch   053000","code_information":[{"code":"7719375","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 50Mm Head Std 190Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719376","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2610.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X20Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7719377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 5X100Mm Conn Hoffmann Ii Compact Yellow Carbon Fiber Mri-Safe","code_information":[{"code":"7719378","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Nerve Block Sgl Shot Stimuplex Ultra 360 20Ga 4In 30Deg Bevel Tip Stimulating Echo Insul","code_information":[{"code":"7719379","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Half Pin Extern Fixat 5X50Mm Traction Ankle Foot Jet-X Ss Ti Nitride Ns","code_information":[{"code":"7719380","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat Strt Metaphyseal Diaphyseal Jet-X Freedom Anodized Alum Ti Ss F/10.5-5Mm Bar/Pin","code_information":[{"code":"7719381","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2504.0,"discounted_cash":1001.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat Strt Metaphyseal Diaphyseal Jet-X Freedom Alum Anodized Ti Ss F/10.5Mm Bar/Pin","code_information":[{"code":"7719382","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2504.0,"discounted_cash":1001.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat 10.5X200Mm Sm Bone Jet-X Carbon Fiber Ns Disp","code_information":[{"code":"7719383","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat 10.5X300Mm Unilateral Sm Bone Jet-X Carbon Fiber Ns Disp","code_information":[{"code":"7719384","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":360.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Soft Tissue Opus Magnum Autocuff Knotless","code_information":[{"code":"7719385","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":435.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dvr 3.5X18Mm Full Thread Cortic Ti Cruciform Head Magenta Dist Volar Radial F/Anatomic","code_information":[{"code":"7719386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":122.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2.5X24Mm Screw Lck Perm Partial Thread Cocr Dist Radial Volar Blue Ns","code_information":[{"code":"7719387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":122.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Link Spinal Silhouette Tie","code_information":[{"code":"7719388","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Centralizer Stem Cementralizer 11Mm Pmma Dist Femur Hip Strl","code_information":[{"code":"7719389","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719390","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X80Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719391","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X40Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719392","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719393","type":"CDM"},{"code":"271","type":"RC"},{"code":"99070","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719394","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Connector Tubing Maxzero 0.19Ml Priming Ndlless Inject Site Zero Reflux End Cap Plus Ll Vlv Lf","code_information":[{"code":"7719396","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Spinal Cd Horizon M8 Legacy 5.5X70Mm Pre-Bent Ti Cervical","code_information":[{"code":"7719397","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1409.0,"discounted_cash":563.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Polydek Ii Dm9040 Braid Nonabsorbable","code_information":[{"code":"7719398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular 60Mm Cluster-Hole Hemis Primary Revis Modul Solid Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7719399","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8780.0,"discounted_cash":3512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X60Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7719400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 4X40Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719401","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 4X80Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719402","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Nanocross Elite Dilatat 3X120Mm 150Cm Otw Semi-Compli F/Pta Ultra Lo-Pro","code_information":[{"code":"7719403","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4991.0,"discounted_cash":1996.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Compress Safeguard 24Cm Press Assist Elastic F/Hemostasis Manage Dressing","code_information":[{"code":"7719404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone A.L.P.S 4X48Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Trac Pad Only                    M8275057/10","code_information":[{"code":"7719406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat 10.5X350Mm Unilateral Sm Bone Jet-X Carbon Fiber Ns Disp","code_information":[{"code":"7719407","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X26Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X30Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719409","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X38Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 206Mm 8-Hole Pre-Contoured Compress Lck Ss Rt Condylar Femur F/4.5Mm Screw Ns","code_information":[{"code":"7719411","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4366.0,"discounted_cash":1746.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw,Cortical 3.5 X 12                          Cs-12","code_information":[{"code":"7719412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":122.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 13Mm Twist-Off","code_information":[{"code":"7719413","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Matrix Bone Graft Allograft Void Filler 10Ml Non-Hemolytic Inject Dbm","code_information":[{"code":"7719414","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4712.0,"discounted_cash":1884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Eon Size 9 12.6Mm Dist 46X140Mm Cement Std Offst Cocr 132Deg Angle Taper 40Mm","code_information":[{"code":"7719415","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12771.0,"discounted_cash":5108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Instrument Ortho 4.5Mm/6.5Mm Conical Easy Out Cannul","code_information":[{"code":"7719416","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X50Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X30Mm Full Thread Self-Tap Cortic Ss Periarticular Ns","code_information":[{"code":"7719418","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X32Mm Full Thread Self-Tap Cortic Ss Periarticular Ns","code_information":[{"code":"7719419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3.2X195Mm Qck-Conn Ss","code_information":[{"code":"7719420","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Nephrostomy Flexima 8Frx25Cm Reg Duromet W/Metal/Flexible Stiffen Cann Lck Pig Glidex Pur","code_information":[{"code":"7719421","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Introducer Cath Performer 5Frx13Cm Check-Flo Vlv Band 0.035In Gw","code_information":[{"code":"7719422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Performer 2.6Mmx8Frx13Cm W/20Cm Dilator 0.038In Gw","code_information":[{"code":"7719423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Splashwire 0.035Inx150Cm 3Cm Angle Tip Fixed Core Std Steer Hydrphil Nitinol Tungsten","code_information":[{"code":"7719424","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Catheter Nephrostomy Ultraxx Unbs-10-15 10Mm 15Cm Bln Percutan W/0.038In Gw 30Fr 17Cm Ptfe","code_information":[{"code":"7719425","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1154.0,"discounted_cash":461.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Thrombect Uni-Fuse Infusion 5Frx90Cm 20Cm Slit Occlud Flow-Thru Hub Ball Wire Press Outlet","code_information":[{"code":"7719426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 54Mm Multi-Hole Primary Sector Porocoat","code_information":[{"code":"7719427","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7958.0,"discounted_cash":3183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Connector Neg Press V.A.C. Trac Y-Shaped","code_information":[{"code":"7719428","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 4X34Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":656.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Persona 3.5X48Mm Headed Unicompart Ss Gold Knee F/High-Flex System","code_information":[{"code":"7719430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Joint Instrument Knee Unicompart 48Mm","code_information":[{"code":"7719431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 3 66Mm/42Mm 17.5Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7719432","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4303.0,"discounted_cash":1721.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3.2X170Mm Prox Femur Cannul Quick-Coupling Gold Ss Ns F/4.5Mm Lcp Screw","code_information":[{"code":"7719433","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1366.0,"discounted_cash":546.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X85Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Hfx Size 6 30Mm Offst 120Mm Cement Primary Reconstruct Cocr 132Deg Angle 25Mm","code_information":[{"code":"7719435","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4296.0,"discounted_cash":1718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat 10.5X150Mm Sm Bone Jet-X Carbon Fiber Ns Disp","code_information":[{"code":"7719436","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X38Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719437","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cement Bone 40Gm Chlorophyll Green Strl Us","code_information":[{"code":"7719438","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X12Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719439","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X50Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X24Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719441","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X30Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X25Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X40Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X45Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X55Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Catheter Hemodialysis Arrow Cannon Ii Plus Smart Seal Chronic 15Frx28Cm 23Cm Tip To Cuff 2Lumen","code_information":[{"code":"7719447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":612.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Catheter Hemodialysis Arrow Cannon Ii Plus Smart Seal Chronic 15Frx32Cm 27Cm Tip To Cuff 2Lumen","code_information":[{"code":"7719448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":612.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Knife Ophthal Stab Convent 20Ga 1.1Mm Strt Sidept Edgeahead F/Mvr Incision","code_information":[{"code":"7719449","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho T2 3Mm 1000Mm Ball Tip Ti Femur F/Intramedullary Nailing System Strl Gam","code_information":[{"code":"7719450","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho T2 +10X11.5Mm Ti Tibial F/Intramedullary Nail Strl","code_information":[{"code":"7719451","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X44Mm Non-Locking Full Thread Self-Tap Solid Cancell Timax Hex Drive Dist Fibula","code_information":[{"code":"7719452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 32Mm -3.5Mm Neck 12/14 Taper Primary Endoprosthesis Cocr Hip Strl","code_information":[{"code":"7719453","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3164.0,"discounted_cash":1265.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Hfx Size 5 29Mm Offst 110Mm Cement Primary Reconstruct Cocr 132Deg Angle 25Mm","code_information":[{"code":"7719454","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6210.0,"discounted_cash":2484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Stapler Inter Proximate 33Mm Circ 2-Row W/4Mm Leg 28 24.4Mm Knife Lf Strl Disp F/Prolapse","code_information":[{"code":"7719455","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X36Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719456","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X65Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 5Mm Short 30Mm Ankle Foot Jet-X Ss Ns","code_information":[{"code":"7719459","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Ilizarov 40Mm Thread Cannul Wire Slot Sm Bone Ss Ns Reus","code_information":[{"code":"7719460","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 52Mm Head Std 190Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719461","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2490.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 11X163Mm 12-Hole Dynamic Compress Lck Ss Limit-Cont Basic Metaphyseal F/3.5Mm","code_information":[{"code":"7719462","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1254.0,"discounted_cash":501.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lc-Dcp 11X189Mm 14-Hole Dynamic Compress Lck Ss Limit-Cont Basic Metaphyseal F/3.5Mm","code_information":[{"code":"7719463","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1867.0,"discounted_cash":746.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 78Mm 4/6-Hole 1.5Mm T-Shaped Oblique Rt Angle Pre-Contoured Compress Lck Ss Prox","code_information":[{"code":"7719464","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1280.0,"discounted_cash":512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 87Mm 3/7-Hole 1.5Mm T-Shaped Oblique Rt Angle Pre-Contoured Compress Lck Ss Prox","code_information":[{"code":"7719465","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1605.0,"discounted_cash":642.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filter Smoke Evacuator Ulpa Wall Suction Multi-Use In-Line F/Por Conn","code_information":[{"code":"7719466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Countersink Drill 2.7Mm Cannul Ns F/3.5/4Mm Screw","code_information":[{"code":"7719467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lc-Dcp 3.5X60Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Dist","code_information":[{"code":"7719468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Lcs Complete Lg Cement 3-Peg Rotat Pe Metal","code_information":[{"code":"7719469","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2976.0,"discounted_cash":1190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Inner Shiley Size 6 7.5Mm Adult Flex Pvc Lf Dehp-Free Strl Disp F/Tracheostomy Tube 15Mm","code_information":[{"code":"7719470","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Pin Fixat Rigidfix 2.7Mm Absorb Cross Femur Acl Soft Tissue Btb W/2-Sleeve Interlocking Trocar","code_information":[{"code":"7719471","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Esoph Combitube 37Fr Sm Adult Tracheal 2Lumen Cuffed","code_information":[{"code":"7719472","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Jet-X 3.5Mm Qck-Conn Ao Ns","code_information":[{"code":"7719473","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat Traction 10.5X250Mm Sm Bone Jet-X Carbon Fiber Ns Disp","code_information":[{"code":"7719474","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Nexgen Size 8 82/54Mm Stemmed C/R Tivanium Pmma Uhmwpe Precoat Lt Rt Knee Blue Strl","code_information":[{"code":"7719475","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":3042.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X70Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Cath Brite Tip Sheath 6Fr Taper Dual Layer Slix Manicured W/Mini-Wire 35Mm Dilator 11Cm","code_information":[{"code":"7719477","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im T2 10Mm Std 375Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7719478","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4411.0,"discounted_cash":1764.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X70Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7719479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X65Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7719480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X55Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7719481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X50Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7719482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander,Tissue      350-4304M","code_information":[{"code":"7719483","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":843.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 48Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719484","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2490.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Axsos Twist 3.2Mm Short 145Mm Qck-Conn Coupl Ao Fit Cannul Calib Ti Strl F/Matta Pelvic","code_information":[{"code":"7719485","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 11X360Mm Cannul Lck Antegrade/Retrograde Femur Ti Alloy Strl","code_information":[{"code":"7719486","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4466.0,"discounted_cash":1786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X35Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7719487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill, 4.2X180Mm    1806-4270S","code_information":[{"code":"7719488","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Gamma Iii 4.2X340Mm Tibial Qck-Conn Ao Fit Calib Ss Strl Disp F/S2 Nailing System","code_information":[{"code":"7719489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho T2 8Mm Std Ti Tibial F/Intramedullary Nail Strl","code_information":[{"code":"7719490","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Iabp 2Fr Statlock Lck Crescent Pad Needle-Free Clamp","code_information":[{"code":"7719491","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Arthro 2.4Mmx14In Trocar Tip F/Advantage Profile Badv Interference Screw Reconstruct Ss","code_information":[{"code":"7719492","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 6.4X105Mm Self-Drilling/Tapping Captured Cortic Ti Blue Im Reconstruct","code_information":[{"code":"7719493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Lcp 3.2X210/185Mm 3-Flute Quick-Coupling Calib Ti Ns","code_information":[{"code":"7719494","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 2.3X80Mm Ulnar Cannul Chuck End F/2.7Mm Screw Total Wrist Fusion Plate Dist Fixat","code_information":[{"code":"7719495","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pacemaker Cardiac Versa Dr Implant 2-Chamber Ppm System","code_information":[{"code":"7719496","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":26271.0,"discounted_cash":10508.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sphere,Eye,20         E5617-20 Silicone","code_information":[{"code":"7719497","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 4 69Mm/44Mm 17.5Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7719498","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4010.0,"discounted_cash":1604.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Gamma3 4.2X260Mm Tibial Qck-Conn Ao Fit Calib Strl F/T2 Nailing System","code_information":[{"code":"7719499","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":247.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat Traction 5Mm Short 110Mm 40Mm Thread Ankle Foot Jet-X Ss Ti Nitride Ns","code_information":[{"code":"7719500","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sensor Radial Art   Tra-200Pro T-Line Sensor Radial Artery","code_information":[{"code":"7719501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture,Vicryl,Keith 4-0  J662H","code_information":[{"code":"7719502","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clip Suture Inter Lap Polymer Poly Kidney Mold Absorb Violet F/2-0/3-0/4-0 Coat Vicryl Lapra-Ty","code_information":[{"code":"7719503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spatula Surg 33Cm Round","code_information":[{"code":"7719504","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Retractor Lap Endo Paddle Retract 12X10Mm Shaft 41X61Cm 31Cm Rect Strt Hndl Atraum Tissue Black Disp","code_information":[{"code":"7719505","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter, Gastric Balloon Suct                         B-202","code_information":[{"code":"7719506","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":233.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trocar,Bladeless 5 X 75   B5Lt With Stabilizer Sleeve","code_information":[{"code":"7719507","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Array 5.5X40Mm Self-Tap Multiaxial Cancell Pedicle Ti Cervical Strl","code_information":[{"code":"7719508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4844.0,"discounted_cash":1937.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Screw Spinal 10.5X30Mm Array Ti Hex Gold F/Open Implant","code_information":[{"code":"7719509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fiber Laser F/Pvp Laserscope","code_information":[{"code":"7719510","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":4035.0,"discounted_cash":1614.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bandage Compress Tipstop 3/4In X 3 7/8In Polyamide Alginate Film Strl F/Trauma","code_information":[{"code":"7719511","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clip Aneurysm Yasargil Temp Std 9Mm 7Mm Open 4.7N 70G Close Force Strt Box Lock Gold Spring Blade","code_information":[{"code":"7719512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1111.0,"discounted_cash":444.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clip Aneurysm Yasargil Temp Std 8.4Mm 6.8Mm Open 4.7N 70G Close Force Slight Curve Box Lock Gold","code_information":[{"code":"7719513","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1111.0,"discounted_cash":444.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.7X125Mm 3-Flute Quick-Coupling Calib Ns","code_information":[{"code":"7719514","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Ethibond Excel 2-0 30In 1/2 Circ Sh Taper Point Ethalloy Green 1 Strand/Pk X833H Uni-Direct","code_information":[{"code":"7719516","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene #0 30In 1/2 Circ Sh Taper Point Blue 1 Strand/Pk 8834H Uni-Direct Monofil Pp 26Mm","code_information":[{"code":"7719517","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Ethibond Excel #0 30In 1/2 Circ Sh Taper Point Ethalloy Green 1 Strand/Pk X834H Uni-Direct","code_information":[{"code":"7719518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Retriever Endo Roth Net 2.5Mm Sheath 230Cm 4X5.5Cm Snare F/Grasping Foreign Body Platin Strl Disp","code_information":[{"code":"7719519","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Binder Abdomin 1-Panel Std Univ 12In Unisex 72-84In Hk-Loop Close Elastic Lf Plain Box","code_information":[{"code":"7719520","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Cre Dilatat Endo 7.5Frx240Cm 10-12Mmx5.5Cm Esoph Pyloric Colonic Wire Guide Pebax Strl","code_information":[{"code":"7719521","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pin Bone Fixat Rush 4.8X279Mm Rod Perm Ss Im Ns","code_information":[{"code":"7719522","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Array 6.5X40Mm Self-Tap Multiaxial Cancell Pedicle Ti Cervical Strl","code_information":[{"code":"7719523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4844.0,"discounted_cash":1937.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endocatch Bag          173050G","code_information":[{"code":"7719524","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 96Mm 3/7-Hole T-Shaped Oblique Angle Pre-Contoured Compress Lck Ss Lt Prox Diaphyseal","code_information":[{"code":"7719525","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1300.0,"discounted_cash":520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X14Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X16Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719527","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X22Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X40Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X18Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.1X112Mm 8-Hole Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic F/3.5Mm","code_information":[{"code":"7719531","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1693.0,"discounted_cash":677.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X48Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7719532","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4293.0,"discounted_cash":1717.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X60Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7719533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X75Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7719534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X54Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7719535","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4293.0,"discounted_cash":1717.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary Paramount Mini Gps 5X14Mm 80Cmx17Mm Bln Bln-Expand Pre-Mount Lo-Pro Ss 0.014In Gw","code_information":[{"code":"7719536","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4991.0,"discounted_cash":1996.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Nanocross Elite Dilatat 2X40Mm 150Cm Otw Semi-Compli F/Pta Ultra Lo-Pro","code_information":[{"code":"7719537","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4991.0,"discounted_cash":1996.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Nanocross Elite Dilatat 3X40Mm 150Cm Otw Semi-Compli F/Pta Ultra Lo-Pro","code_information":[{"code":"7719538","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4991.0,"discounted_cash":1996.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X120Mm 135Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7719539","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 8X40Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719540","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Endocatch-Ii, Bag       173049 Specimen Pouch    Endocatch-I","code_information":[{"code":"7719541","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":258.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl #0 27In 1/2 Circ Ct-2 Taper Point Violet 1 Strand/Pk J334H Uni-Direct Coat Braid","code_information":[{"code":"7719542","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Prolene 5-0 36In 3/8 Circ C-1 Dbl-Arm Taper Point Ethalloy Blue 1 Strand/Pk 8720H Uni-Direct","code_information":[{"code":"7719543","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X20Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Dist Radial","code_information":[{"code":"7719544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X18Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Dist Radial","code_information":[{"code":"7719545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X22Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Dist Radial","code_information":[{"code":"7719546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X20Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Green Dist","code_information":[{"code":"7719547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":155.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X14Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Green Dist","code_information":[{"code":"7719548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":160.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1.8X110Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End W/Depth Mark Gold Ss Ns","code_information":[{"code":"7719549","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 2-0 27In 1/2 Circ Ct-2 Taper Point Undyed 1 Strand/Pk J269H Uni-Direct Coat Braid","code_information":[{"code":"7719550","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nut,10Mm Ilizarov       103300","code_information":[{"code":"7719551","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Counter Extern Fixat Ilizarov 10Mm Square Head Compress Distract 4-Point Ankle Foot Ss Ns Reus","code_information":[{"code":"7719552","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Ilizarov 20Mm 5-Hole Conn Sm Bone Ss Ns Reus","code_information":[{"code":"7719553","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat 180Mm Long Foot-Shaped Plate Ilizarov Taylor Spatial Frame Alum Strl","code_information":[{"code":"7719554","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4142.0,"discounted_cash":1656.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Extern Fixat Ilizarov 1.8X370Mm Bayonet Point Hp Cortic Ss Ns Reus 12/Bx","code_information":[{"code":"7719555","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hinge Extern Fixat Ilizarov 90Mm Thread Male Support Hp Ankle Foot Ss Ns Reus","code_information":[{"code":"7719556","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Post Extern Fixat Ilizarov 3-Hole Male Support Lg Bone Ss Ns Reus","code_information":[{"code":"7719557","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Ilizarov 30Mm Thread Slot Femur Sm Bone Ss F/Wire Basic Set Adult Ns Reus","code_information":[{"code":"7719558","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 49Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7719559","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2490.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X28Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X38Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 26X43Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7719562","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4573.0,"discounted_cash":1829.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 26Mm +0Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7719563","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3417.0,"discounted_cash":1366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X57Mm Bipol Modul Cup Ball Cocr Hip Blue","code_information":[{"code":"7719564","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3208.0,"discounted_cash":1283.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Restrictor Cement  5463-08-000 Size 8","code_information":[{"code":"7719566","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":237.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Arthro Vapr 4Mm 90Deg Suction V3 Rf Integrate Handpiece Strl Disp","code_information":[{"code":"7719567","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":332.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 52Mm Multi-Hole Primary Sector Porocoat","code_information":[{"code":"7719568","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4860.0,"discounted_cash":1944.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Pinnacle 6.5X30Mm Dome Self-Tap Polyaxial Gription Ti Foam Cancell Strl","code_information":[{"code":"7719569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Follower 10-24Frx13.35In Plastic Pvc Blend Coude Tip Disp","code_information":[{"code":"7719570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Trigen 10X380Mm 130Deg Angle Cannul Lck Antegrad Reconstruct Rt Femur Trochan Ti Alloy","code_information":[{"code":"7719571","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6986.0,"discounted_cash":2794.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 250Mm Thread Lg Bone Tibial Ilizarov Ss F/Foot Ankle System Ns 5/Bx","code_information":[{"code":"7719572","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Post Extern Fixat Ilizarov 2-Hole Male Support Lg Bone Ss Ns Reus","code_information":[{"code":"7719573","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur P.F.C Sigma Tc3 Size 4 71/65Mm Cement Post Stabil C/S Revis Cocr Non-Porous Lt","code_information":[{"code":"7719574","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15441.0,"discounted_cash":6176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial S-Rom Noiles Size 4 74.9/49.3Mm 4.8Mm Cement Post Stabil Tricompart Revis","code_information":[{"code":"7719575","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":12029.0,"discounted_cash":4811.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Sigma Tc3 Size 4 76Mm/51Mm 10Mm Post Stabil Rotat Platform Uhmwpe","code_information":[{"code":"7719576","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6881.0,"discounted_cash":2752.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Tempo Selective 5Frx100Cm Bern Nsh Braid Thrulumen Neon Tip Cerebral Gray","code_information":[{"code":"7719577","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial P.F.C Sigma Size 2.5 64Mm/40Mm 10Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7719578","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3822.0,"discounted_cash":1528.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 5 74Mm/47Mm 10Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7719579","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3822.0,"discounted_cash":1528.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Tubing Irrigat Cystogram","code_information":[{"code":"7719580","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Vista Brite Tip Ig 8Frx0.088Inx55Cm Renal Dbl Curve1 Sm 16Mm Hybrid Braid W/Sheath","code_information":[{"code":"7719581","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Storq 180Cm  503-456 .035","code_information":[{"code":"7719582","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Storq 300Cm  503456X .035","code_information":[{"code":"7719583","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Super Torque Mb Flush 5Frx65Cm Pig 8Sh Braid 20-Band Gray Ss Pur Pcte Marker","code_information":[{"code":"7719584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Tempo Selective 5Frx65Cm Bern Nsh Braid Thrulumen Neon Tip Cerebral Gray Nylon","code_information":[{"code":"7719585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Tempo Jb1   451-523H0 5Fr 100Cm","code_information":[{"code":"7719586","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Marker Pig   532-598B 5Fr 110Cm","code_information":[{"code":"7719587","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Tempo Selective 4Frx65Cm Cob1 Nsh Braid Thrulumen Neon Tip Visceral Red Nylon","code_information":[{"code":"7719588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shuttlecock Cath Long   G48153 4.5Fr X 135Cm","code_information":[{"code":"7719589","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":65.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 7X40Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719590","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X40Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719591","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X60Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719592","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X80Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719593","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 8X60Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719594","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 12X40Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719595","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 7X80Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719596","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":309.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4.3X180Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns F/Lcp Screw","code_information":[{"code":"7719597","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 5X70Mm Compress Lck Full Thread Self-Tap Ss T25 Stardrive Recess Green Prox Medial","code_information":[{"code":"7719598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X65Mm Compress Lck Full Thread Self-Tap Ss T25 Stardrive Recess Green Prox Medial","code_information":[{"code":"7719599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X53Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7719600","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4573.0,"discounted_cash":1829.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Omnifit Torx 6.5X30Mm Ss Cancell Strl","code_information":[{"code":"7719601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Omnifit Torx 6.5X16Mm Ss Cancell Strl","code_information":[{"code":"7719602","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 36Mm +5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7719603","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3944.0,"discounted_cash":1577.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Reciprocating   5052-258 12.5Mm X 89Mm","code_information":[{"code":"7719604","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Oscillating     5071-583 12.7Mm X 90Mm X .89Mm","code_information":[{"code":"7719605","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Oscillating     5071-547 25.4Mm X 86.0Mm X 1.19Mm","code_information":[{"code":"7719606","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Reciprocator    5052-291 12.5Mm X 76Mm X 1.2Mm","code_information":[{"code":"7719607","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X62Mm +4 10Deg Angle Lat Marathon","code_information":[{"code":"7719609","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4289.0,"discounted_cash":1715.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Suture Removal Shoulder W/5-Sheath 1-Threader Suture Saver","code_information":[{"code":"7719610","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X22Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X34Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X36Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glidecath Angled         Cg507 65Cm","code_information":[{"code":"7719614","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Glidecath 5Frx100Cm 25Cm/40Cm Strt Sgl Braid Lg Lumen Small-Profile Periph","code_information":[{"code":"7719615","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Glidecath 4Frx120Cm 15Cm/40Cm Non-Tapered Ang Dbl Braid Lg Lumen Small-Profile","code_information":[{"code":"7719616","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Saw             5071-548","code_information":[{"code":"7719617","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Variax 0.045Inx160Mm Kirschner Temp Len Mark Ss W/Lock Set Ns","code_information":[{"code":"7719618","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Variax Twist 1.9X105Mm 41Mm Cmf Ao Shaft End Ns","code_information":[{"code":"7719619","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Variax Twist 2X105Mm 41Mm Cmf Ao Shaft End Ns","code_information":[{"code":"7719620","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.3X18Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Stardrive","code_information":[{"code":"7719621","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X16Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7719622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":104.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Intergro 10Ml Syringe Dbm","code_information":[{"code":"7719623","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4486.0,"discounted_cash":1794.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Basket Stone Retrieval 5711222","code_information":[{"code":"7719624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":358.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Perma-Hand 3-0 30In 1/2 Circ Sh Taper Point Black 1 Strand/Pk K832H Uni-Direct Wax Coat","code_information":[{"code":"7719625","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Line Angiography Tubing 0.071X48In Pur High Press Braid Flex Airless Rotat M/F Adapt W/Keep Clip","code_information":[{"code":"7719626","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Variax 2.7X18Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Stardrive Ns","code_information":[{"code":"7719627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X20Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Stardrive Ns","code_information":[{"code":"7719628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X14Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7719629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":104.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.3X20Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Stardrive","code_information":[{"code":"7719630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Paste Bone Graft Intergro 5Ml Syringe Dbm W/Luer/Nozzle Cap Ext","code_information":[{"code":"7719632","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2532.0,"discounted_cash":1012.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl #0 27In 5/8 Circ Ur-6 Taper Point Violet 1 Strand/Pk J603H Uni-Direct Coat Braid","code_information":[{"code":"7719633","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 5X44Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7719634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4.5Mm Cannul S-Cp","code_information":[{"code":"7719635","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":372.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X40Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":298.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X38Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7719637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.0,"discounted_cash":298.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Lcs Complete Standard+ Cement 3-Peg Rotat Pe Metal","code_information":[{"code":"7719638","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2999.0,"discounted_cash":1199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 5Mm Short 110Mm 40Mm Thread Ankle Foot Jet-X Ss Ti Nitride Ns","code_information":[{"code":"7719639","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Apligraf 44Sqcm 2Layer Fibroblasts Keratinocytes Stem Cell Skin >2Yr Shelf","code_information":[{"code":"7719640","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"gross_charge":4816.0,"discounted_cash":1926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X44Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X32Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719642","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stimulator Bone Implant W/Lead Strt Cathode Detach Conn 20A Generator Ebi Osteogen 20/S","code_information":[{"code":"7719643","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":22563.0,"discounted_cash":9025.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 9In 7Mml Thread Cannul","code_information":[{"code":"7719644","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 206Mm 8-Hole Pre-Contoured Compress Lck Ss Lt Condylar Femur F/4.5Mm Screw Ns","code_information":[{"code":"7719645","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5121.0,"discounted_cash":2048.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X46Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X62Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X58Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7719648","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Ilizarov Univ 16Mm 5-Hole Hng Conn Sm Bone Ss F/Foot Ankle System W/Clamp Ns Reus","code_information":[{"code":"7719649","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cross Connector Spinal Polaris Med Modul Ti Lumb F/5.5Mm Rod","code_information":[{"code":"7719650","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5754.0,"discounted_cash":2301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Extern Fixat 2X14Mm Ankle Foot Ilizarov Ss","code_information":[{"code":"7719651","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 5Mm Short 110Mm 30Mm Non-Threaded Unilateral Ankle Foot Jet-X Ss Ti Nitride Ns","code_information":[{"code":"7719652","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Bit 3.5Mm    4806-110-35","code_information":[{"code":"7719653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5Mm Short 110Mm Qck-Conn Ss Ns","code_information":[{"code":"7719654","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X16Mm Non-Cannulated Lck Self-Tap Fixed Angle Cortic Ss Periarticular Elbow W/2.7Mm","code_information":[{"code":"7719655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X22Mm Non-Cannulated Lck Self-Tap Fixed Angle Cortic Ss Periarticular Elbow W/2.7Mm","code_information":[{"code":"7719656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Forte 4X18Mm Full Thread Cancell Ss Hex Head Ns","code_information":[{"code":"7719657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X20Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat 10.5X100Mm Sm Bone Jet-X Carbon Fiber Ns Disp","code_information":[{"code":"7719659","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 5Mm Short 110Mm 35Mm Thread Ankle Foot Jet-X Ss Ti Nitride Ns 71065358","code_information":[{"code":"7719660","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coil Emboliz Mreye 6Mmx5Cm High Radial Force Pushable 2.7-Loop Inconel Synthetic Fiber Mri-Cond","code_information":[{"code":"7719661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Embolization Nester 8Mm 14Cm Pushable 5.6-Loop Synthetic Fiber Platinum Mri-Conditional Ra","code_information":[{"code":"7719662","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Nester G26994 6Mmx14Cm Pushable Low Temp Synthetic Fiber Platin Mri-Cond 0.035In","code_information":[{"code":"7719663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Lunderquist Extra Support Exchange 0.035Inx260Cm 4Cm Tip 11Cm Taper 15Cm Coil Strt","code_information":[{"code":"7719664","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture 4-0 Prolene V7    8975H","code_information":[{"code":"7719665","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture 5-0 Prolene V5    8934H","code_information":[{"code":"7719666","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Perma-Hand 2-0 30In Ties Black 10 Strands/Pk Sa85H Uni-Direct Wax Coat Braid W/O Needle","code_information":[{"code":"7719667","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 2-0 18In Ties Undyed 12 Strands/Pk J911T Uni-Direct Coat Braid Pre-Cut Polyglactin 910","code_information":[{"code":"7719668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Snare Vasc Atrieve Std Retriev 18-30Mmx120Cm 15Deg 3-Short Profile Loop W/7Fr 100Cm Cath Intro","code_information":[{"code":"7719669","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":555.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dilator Coons 18Fr X 20Cm                  Jcd18.0-38-20","code_information":[{"code":"7719670","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilator Vasc Std Coons 20Frx20Cm Taper Lf Strl Disp 0.038In Gw","code_information":[{"code":"7719671","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Cath Performer 16Frx35Cm Strt Tip Check-Flo Vlv Transsept Band 0.038In Gw","code_information":[{"code":"7719672","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Joint Instrument Knee Unicompart 33Mm","code_information":[{"code":"7719673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Size E Cement Unicompart High Flexion Cocr Pmma Rt Medial Lt Lat","code_information":[{"code":"7719674","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12029.0,"discounted_cash":4811.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 3 8Mm Unicompart Pe Rt Medial Lt Lat","code_information":[{"code":"7719675","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6223.0,"discounted_cash":2489.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Port Infusion M.R.I. Non-Power Inject Intermed Implant 9.6Fr Plastic 1Lumen Full-Size Profile","code_information":[{"code":"7719676","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2088.0,"discounted_cash":835.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Zuk Size C Unicompart High Flexion Zimaloy Lt Medial Rt Lat Knee","code_information":[{"code":"7719677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10108.0,"discounted_cash":4043.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 28X52Mm Neutral 0Deg Angle Lat Marathon","code_information":[{"code":"7719678","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3279.0,"discounted_cash":1311.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Thrombect Uni-Fuse Infusion 5Frx135Cm 50Cm Slit Occlud Flow-Thru Hub Ball Wire Press Outlet","code_information":[{"code":"7719679","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":288.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tray Kyphoplasty Kyphopak 1St Frx W/Size 2 10Mm Kyphon Express 2-Ibt Osteo Intro 8-Bone Filler","code_information":[{"code":"7719680","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14861.0,"discounted_cash":5944.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 7 133Mm Cement High Offst Collar Cocr Porocoat 130Deg Angle 12/14 Taper 41Mm","code_information":[{"code":"7719681","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9771.0,"discounted_cash":3908.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Trilogy 6.5X20Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cortic Strl","code_information":[{"code":"7719682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Secure 2N8200 Tube Univ Vital Holder Med Adhes Neutral Lf Strl F/3-8Mm Tubing","code_information":[{"code":"7719683","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Size E Unicompart High Flexion Zimaloy Lt Medial Rt Lat Knee","code_information":[{"code":"7719684","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12029.0,"discounted_cash":4811.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 4 Univ 8Mm Unicompart Pe Rt Medial Lt Lat","code_information":[{"code":"7719685","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6223.0,"discounted_cash":2489.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Micropuncture Introdr Mpis-501","code_information":[{"code":"7719686","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg Hi-Line Xs Rosen Size 2 5Mm Strl Disp","code_information":[{"code":"7719687","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 2X152Mm Kirschner Temp Smooth Single-Ended Plain Diamond Point Style 6 Ss","code_information":[{"code":"7719688","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tack Ortho Forefoot/Midfoot Lck F/Plate Fixat Ns Pl-Ptack","code_information":[{"code":"7719689","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acu-Loc 3.5Mmx5In Clavicle Qr Calib Ss Strl F/Scapula Plate System","code_information":[{"code":"7719690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Polarus 3.5X45Mm Non-Locking Cortic Ti Dist Radial Ns","code_information":[{"code":"7719691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X30Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7719692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X55Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7719693","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stapler Inter Echelon Contour Gst Cutter 40X51Mm Thk Tissue Curve Head 4-Row 6-Firing Green","code_information":[{"code":"7719694","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1596.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reload Staple Echelon Contour Gst Cutter 40Mm 4.7/2Mm Open/Closed Thk Tissue Curve Head 3D","code_information":[{"code":"7719695","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg Hi-Line Xs Rosen Size 3 6Mm Strl Disp","code_information":[{"code":"7719696","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Applier Clip Antrum Backbiter Ostrum 2.5Mm 3 7/8In Ss Reus Or Grd","code_information":[{"code":"7719697","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":99.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Barrier Adhesion Seprafilm 3X5In Dressing Na Hyaluron Carboxymethyl Cellulose Membrane 6/Pk","code_information":[{"code":"7719699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":1787.0,"discounted_cash":714.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Seprafilm 5 X 6       4301-02","code_information":[{"code":"7719700","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":293.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acu-Loc 2Mmx5In Clavicle Qr Calib Ss Strl F/Scapula Plate System","code_information":[{"code":"7719701","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Acumed 0.059In Strt 6In Trocar Tip Ss","code_information":[{"code":"7719702","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial P.F.C Sigma Size 5 74Mm/47Mm 12.5Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7719703","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3822.0,"discounted_cash":1528.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X30Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X38Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X50Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719706","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X55Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 8X350Mm Conn Hoffmann Ii Yellow Carbon Fiber Mri-Safe","code_information":[{"code":"7719708","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":843.0,"discounted_cash":337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Expert 52Mm Spiral Solid Ti Humeral Gold Ns","code_information":[{"code":"7719709","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1884.0,"discounted_cash":753.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Germicid Biopatch Protect 1In Disk 7Mm Hole Round Disc Antimic Hydrphil Absorb Blue Non-Gel","code_information":[{"code":"7719710","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dressing Germicid Biopatch Protect 1In Disk 4Mm Hole Round Antimic Hydrphil Absorb Blue Non-Gel Chg","code_information":[{"code":"7719711","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dressing Foam Mepilex Slf-Adher 6.3X7.9In Sacral 5-Layer Border Absorb Pur Strl 10/Bx","code_information":[{"code":"7719712","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dressing Foam Allevyn Life Adhes 4X4In Sacral Quadrilobe Multi-Layer Border High Absorb Change","code_information":[{"code":"7719713","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Mepilex Border Heel Foam Dressing With Safetac 8.7 X 9.1","code_information":[{"code":"7719714","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Variax 53Mm 9-Hole 2Mm Short Univ Narrow Ti Polyaxial Dist Volar Radial F/2.7Mm Screw","code_information":[{"code":"7719715","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2659.0,"discounted_cash":1063.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X32Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Connector Extern Fixat Ilizarov Univ Std Hinge F/Foot Ankle System","code_information":[{"code":"7719717","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1865.0,"discounted_cash":746.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X95Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":770.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Gamma3 4.2Mm Sm 300Mm Im Ao Shaft End Ss Strl","code_information":[{"code":"7719719","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":294.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Screw Bone Gamma3 8X17.5Mm Lck Thread Self-Tap Ti Trochan Hip F/Long Nail System Strl","code_information":[{"code":"7719720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X80Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7719721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X85Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7719722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X20Mm Cannul Full Thread Reduce Head Cancell Timax Ns","code_information":[{"code":"7719723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X34Mm Cannul Full Thread Reduce Head Cancell Timax Ns","code_information":[{"code":"7719724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X46Mm Cannul Full Thread Reduce Head Cancell Timax Ns","code_information":[{"code":"7719725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Size C Unicompart High Flexion Zimaloy Rt Medial Lt Lat Knee","code_information":[{"code":"7719726","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12029.0,"discounted_cash":4811.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Size 3 Cement Unicompart High Flexion Tivanium Rt Medial Lt Lat","code_information":[{"code":"7719727","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7284.0,"discounted_cash":2913.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Inserter Surg","code_information":[{"code":"7719728","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":173.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Zuk Size D Unicompart High Flexion Zimaloy Rt Medial Lt Lat Knee","code_information":[{"code":"7719729","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12029.0,"discounted_cash":4811.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Half 180Mm Sm Bone Ilizarov Carbon F/Foot Ankle System Pvc-Free Ns","code_information":[{"code":"7719730","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3112.0,"discounted_cash":1244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 400Mm 125Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719731","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6706.0,"discounted_cash":2682.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X105Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":770.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 340Mm 130Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719733","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6041.0,"discounted_cash":2416.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X90Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":770.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 1.044X1.854In 50Deg Angle 360Deg Total Rotat Intermed Rod-Rod Cartridge Jet-X","code_information":[{"code":"7719735","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3053.0,"discounted_cash":1221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 3.8Mmx6In Ns Disp","code_information":[{"code":"7719736","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":233.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Versanail 4.4Mmx6In Tibial Calib Ns","code_information":[{"code":"7719737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 3.6Mm 14In Ns Disp","code_information":[{"code":"7719738","type":"CDM"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Affixus 3Mm 80Cm Ball Nose F/Hip Frx Nail System","code_information":[{"code":"7719739","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Quick Clip 2 Long 9Mm                Hx-201Ur-135L.A","code_information":[{"code":"7719740","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Sealant Hemostat Fibrin Tisseel Frz-Dry 2Ml","code_information":[{"code":"7719742","type":"CDM"},{"code":"272","type":"RC"},{"code":"A6250","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X55Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719743","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X60Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719744","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X10Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 340Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719746","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6875.0,"discounted_cash":2750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X100Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719747","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":770.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Prolene 5-0 18In 3/8 Circ C-1 Dbl-Arm Taper Point Ethalloy Blue 1 Strand/Pk 8717H Uni-Direct","code_information":[{"code":"7719748","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Iv Introcan Safety Auto Passive Shield 24Ga 0.55In Teflon Fep Polymer Yellow Strt Hub","code_information":[{"code":"7719749","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719750","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719752","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719753","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 5X75Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7719756","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.1X70Mm 5-Hole 3.5Mm Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic F/3.5Mm","code_information":[{"code":"7719757","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1437.0,"discounted_cash":574.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 340Mm 125Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719758","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6706.0,"discounted_cash":2682.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X85Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":770.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trocar Wire 1.0X150   44112000","code_information":[{"code":"7719760","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trocar Wire  1.6X150  44112008","code_information":[{"code":"7719761","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 360Mm 125Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719762","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6706.0,"discounted_cash":2682.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X110Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1499.0,"discounted_cash":599.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.1X84Mm 6-Hole Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic F/3.5Mm Screw","code_information":[{"code":"7719764","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Grand Slam Asahi 0.014Inx180Cm 3Cm Tip Strt Steer Hydrophob F/Ptca Firm Ro","code_information":[{"code":"7719765","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 14Mm Twist-Off","code_information":[{"code":"7719766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Cath Flexor Sheath Guiding 7Frx45Cm Ansel 2 Modif Renal Dbl Reinforc Check-Flo Hemostat","code_information":[{"code":"7719767","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shears Ultrasonic Harmonic Ace +7 Lap Scalpel 5Mmx36Cm Abdomin Curve Blunt Tip Bladeless Thread","code_information":[{"code":"7719768","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1792.0,"discounted_cash":716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719776","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719777","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Washer Ortho 6.6X13Mm Lg Round Flat F/6.6Mm Cannul Screw","code_information":[{"code":"7719789","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Zuk Size 4 Cement Unicompart High Flexion Tivanium Rt Medial Lt Lat","code_information":[{"code":"7719790","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7284.0,"discounted_cash":2913.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Femoral             5842-24-09","code_information":[{"code":"7719791","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":1278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Protex 6X40Mm Cannul Lck Polyaxial Self-Tap Non-Threaded Pedicle Ti","code_information":[{"code":"7719792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5095.0,"discounted_cash":2038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Spinal Protex Lck Ti","code_information":[{"code":"7719793","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Reliant Stent Graft 10/46Mm P/D 8Fr Shaft 100Cm Lo-Pro Pur 0.038In Gw 12Fr","code_information":[{"code":"7719796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":1894.0,"discounted_cash":757.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Probe Pneumatic        840-733 1Mm X 570Mm","code_information":[{"code":"7719797","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":881.0,"discounted_cash":352.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X90Mm Cannul Lag 20Mm Partial Thread Self-Drilling/Tapping Std Cancell Ti","code_information":[{"code":"7719798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X80Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":770.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Airway Nasophary Rusch 14Frx95Mm Nasal Round Tip Adjust Flange Soft Teal Mediprene Lf Strl Disp","code_information":[{"code":"7719800","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Airway Nasophary Rusch 16Frx95Mm Nasal Round Tip Adjust Flange Soft Teal Mediprene Lf Strl Disp","code_information":[{"code":"7719801","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Airway Nasophary Rusch 24Frx170Mm Nasal Round Tip Adjust Flange Soft Teal Mediprene Lf Strl Disp","code_information":[{"code":"7719802","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill 2Mm Short 125Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns F/Lcp","code_information":[{"code":"7719803","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wand Electrosurgical Coblation Evac 70 Xtra Hp Suction Coblater 3-Wire Electrode Dist Ablative Prox","code_information":[{"code":"7719804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 380Mm 125Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719805","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6875.0,"discounted_cash":2750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 83Mm 6-Hole Buttress Ss Lt Lat Prox Tibial Periarticular F/3.5/4Mm Cort/Canc Screw Ns","code_information":[{"code":"7719806","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2710.0,"discounted_cash":1084.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X34Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719807","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X32Mm Full Thread Self-Tap Cortic Ss Radial Periarticular Ns","code_information":[{"code":"7719808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 1.6X152Mm Kirschner Temp Smooth Single-Ended Plain Diamond Point Style 6 Ss","code_information":[{"code":"7719809","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 360Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719810","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6875.0,"discounted_cash":2750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Lg 25X15X31Mm Peek Ant Thoracolum Vertebral","code_information":[{"code":"7719811","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17599.0,"discounted_cash":7039.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Graft Bone Infuse Sm 1X2In Matrix 2.8Ml Frz-Dry 2-Syringe Rhbmp-2 Acs Lumb Spinal Taper W/1In X","code_information":[{"code":"7719812","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15225.0,"discounted_cash":6090.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bone Graft Infuse Kit  7510400 Medium","code_information":[{"code":"7719813","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19043.0,"discounted_cash":7617.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bone Graft Infuse Kit  7510600 Large","code_information":[{"code":"7719814","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":21163.0,"discounted_cash":8465.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X26Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7719815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Trigen 6.4Mm 15Mm Ext Ti F/Intramedullary Nail","code_information":[{"code":"7719816","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 150Mm Thread Lg Bone Tibial Ilizarov Ss F/Foot Ankle System Ns","code_information":[{"code":"7719817","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Aml 13.5X40X155Mm Cementls Std Offst Collar Sm Stature Ti Full Porocoat 135Deg Angle","code_information":[{"code":"7719818","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13587.0,"discounted_cash":5434.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Penile Ams 700 Ultrex 18Cm Tactile Pump Inflate Pre-Connected Penoscrotal W/Cylinder Tip","code_information":[{"code":"7719819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":23688.0,"discounted_cash":9475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Arthro Vapr 3.5Mm Angle End Effect Rf Non-Suction V2 Mode","code_information":[{"code":"7719820","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Jl5 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7719821","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Jr5 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7719822","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Snare Endo Electrosurgical Snaremaster 0.4Mm Wire 230Cm 15Mm Upper Lower Gi Oval Soft Pliable","code_information":[{"code":"7719824","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Snare Endo Electrosurgical Snaremaster 0.4Mm Wire 230Cm 25Mm Upper Lower Gi Oval Soft Pliable","code_information":[{"code":"7719825","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Gynecare Gynemesh Ps 10X15Cm Graft Prolene Pp","code_information":[{"code":"7719826","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":505.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719827","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 380Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719828","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7303.0,"discounted_cash":2921.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Valve Speaking Pmv Vent Lo-Pro 15X23Mm Swallowing W/Reusable Flex Tubing Purple Rubber Lf","code_information":[{"code":"7719829","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tubing Insufflat Endo Filter Swivel Conn High Flow Strl","code_information":[{"code":"7719830","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Sustain Med 14X8X13Mm Peek Thoracolum Cervical 7Deg Lordot","code_information":[{"code":"7719831","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4884.0,"discounted_cash":1953.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Disc Lap Med Sleeve      Flr02 Fixed Length","code_information":[{"code":"7719832","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2160.0,"discounted_cash":864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 6 8Mm Unicompart Pe Lt Medial Rt Lat","code_information":[{"code":"7719833","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6223.0,"discounted_cash":2489.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho T2 2.2Mm 800Mm Smooth Tip Ti Humeral F/Intramedullary Nailing System Strl","code_information":[{"code":"7719834","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 4X45Mm Lck Full Thread Ti Prox Humeral Tibial Cut 3-Flute F/Intramedullary Nailing","code_information":[{"code":"7719835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Gamma3 3.5X230Mm Humeral Qck-Conn Ao Fit Calib Ss Strl F/T2 Nailing System","code_information":[{"code":"7719836","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Trach Portex Bivona Mid-Range Aire-Cuf Hyperflex Size 9 9X12.9X140Mm Adult Cuffed Adjust Neck","code_information":[{"code":"7719837","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Trach Portex Bivona Mid-Range Aire-Cuf Hyperflex Size 8 8X11.7X130Mm Adult Cuffed Adjust Neck","code_information":[{"code":"7719838","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Ureteral Uromax Ultra Endo High Press Bln 5.8X18Frx75Cm 4Cm Taper Dist End Tip Non-Compli","code_information":[{"code":"7719839","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 420Mm 125Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719842","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7225.0,"discounted_cash":2890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Protege Gps 10X60Mm 80Cm Otw Slf-Expand Pre-Mount Lo-Pro Nitinol","code_information":[{"code":"7719843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4405.0,"discounted_cash":1762.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4X80Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cancell Ti Bullet Shape Tip","code_information":[{"code":"7719844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Polyax 2.5Mm Prox Tibial Qck-Conn Calib","code_information":[{"code":"7719845","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Polyax 3.8Mm Calib F/Locking Plate System","code_information":[{"code":"7719846","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X26Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7719847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Polyax 153.7Mm 5-Hole Pre-Contoured Lck Timax Lt Prox Tibial Ns","code_information":[{"code":"7719848","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5358.0,"discounted_cash":2143.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 12X380Mm Cannul Lck Antegrade/Retrograde Femur Ti Alloy Strl","code_information":[{"code":"7719849","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5269.0,"discounted_cash":2107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Accell Connexus Allograft 10Ml Dbm Human Poloxamer","code_information":[{"code":"7719850","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5564.0,"discounted_cash":2225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vasc Protege Everflex 7X100Mm 120Cm Otw Slf-Expand Pre-Mount Nitinol Iliac Superficial","code_information":[{"code":"7719851","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5772.0,"discounted_cash":2308.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Breast Biopsy Eviva Trocar 9Ga 13Cm 20Mm Aperture Fire Vacuum-Assisted Needle Std W/20-28Mm","code_information":[{"code":"7719852","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Handpiece Breast Biopsy Eviva Trocar 9Ga 13Cm 12Mm Aperture Fire Vacuum-Assisted Needle Petite","code_information":[{"code":"7719853","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guide Needle Biopsy Eviva 9Ga Breast Strl Disp F/Hologic/Siemens/Fischer Mammo Test","code_information":[{"code":"7719854","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Marker Breast Biopsy Securmark Eviva 12Ga 13Cm Mini Cork Site Identifier Ti","code_information":[{"code":"7719855","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 4X65Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7719856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Lcp 1.8X90Mm Maxillofacial 2-Flute J-Latch Coupl Ss Ns F/Modular Hand System","code_information":[{"code":"7719857","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Solution Surg Prep 2Oz 10% Saturate Pvp-I Spray Bottle Lf Hazardous Strl 24/Ca","code_information":[{"code":"7719858","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Et Shiley Taperguard Evac 7X10.4X300Mm 25.4Mm Cuff Subglottic Taper Cuffed Hi-Vol Low-Pressure","code_information":[{"code":"7719859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Et Shiley Taperguard Evac 7.5X11.2X310Mm 25.4Mm Cuff Subglottic Taper Cuffed Hi-Vol","code_information":[{"code":"7719860","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Et Shiley Taperguard Evac 8X11.8X320Mm 25.4Mm Cuff Subglottic Taper Cuffed Hi-Vol Low-Pressure","code_information":[{"code":"7719861","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 4.5X40Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X42Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7719863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Lg 25X11X31Mm Peek Ant Thoracolum Vertebral","code_information":[{"code":"7719864","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17500.0,"discounted_cash":7000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Basket Stone Retriev Gemini 11Mmx2.4Fr Sheath 120Cm Ureteral Helical 5Cm Filiform Tip 3-Paired Wire","code_information":[{"code":"7719865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":286.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Basket Stone Retriev Gemini 11Mmx2.4Fr Sheath 120Cm Ureteral O-Tip Helical 3-Paired Wire Detach Hndl","code_information":[{"code":"7719866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":283.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Detector Carb Diox Neo-Statco2 Easycapii 15X15Mm Female/Male Adult Lf Ns Disp F/15Kg Pt","code_information":[{"code":"7719867","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Detector Carb Diox Nellcor Pedicap6 Ped Colorimetric Lf F/1-15Kg Pt","code_information":[{"code":"7719868","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Microcatheter Vasc Renegade Hi-Flo Transcend-18 Emboliz Support 3/2.8Fr P/D 0.027Inx135Cm Strt","code_information":[{"code":"7719869","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2088.0,"discounted_cash":835.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Trident Size F 36Mm 58-60Mm 9.4Mm 10Deg Angle Primary X3 W/Hemispherical Shell","code_information":[{"code":"7719870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5215.0,"discounted_cash":2086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Acetabular Secur-Fit Apical-Hole","code_information":[{"code":"7719871","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Omnifit Torx 6.5X20Mm Ss Cancell Strl","code_information":[{"code":"7719872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X85Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7719873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X80Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7719874","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X45Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7719875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X40Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7719876","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X6Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7719877","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X8Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7719878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X10Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7719879","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X12Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7719880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X14Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7719881","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X16Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7719882","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X18Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7719883","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lg 53Mm 3/3-Hole 1.25Mm Strt Lck Ti Broad Gold F/2Mm Screw Mandibular Ns","code_information":[{"code":"7719884","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":703.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lg 47Mm 6-Hole 1.25Mm Strt Narrow Lck Ti Gold F/2Mm Screw Mandibular Ns","code_information":[{"code":"7719885","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":703.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lg 95Mm 12-Hole 1.25Mm Strt Lck Ti Gold F/2Mm Screw Mandibular Ns","code_information":[{"code":"7719886","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2012.0,"discounted_cash":804.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Lg 3X3-Hole 1.5Mm Angle Lck Ti Gold F/2Mm Screw Cranfac Mandibular Ns","code_information":[{"code":"7719887","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2420.0,"discounted_cash":968.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lg 3X3-Hole 1.5Mm Crescent Lck Ti Gold F/2Mm Screw Cranfac Mandibular Ns","code_information":[{"code":"7719888","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2420.0,"discounted_cash":968.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Bit 2.Omm       24900008 Locon","code_information":[{"code":"7719889","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Charlotte Sm Ss Fusion Lt Mtp","code_information":[{"code":"7719890","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4927.0,"discounted_cash":1970.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X14Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Stardrive Ns","code_information":[{"code":"7719891","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Variax 2X18Mm Lck Perm Cross Head Smooth Dist Radial Volar","code_information":[{"code":"7719892","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X12Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Stardrive","code_information":[{"code":"7719893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Tubing Ext Mridium 92In 15Ml Priming Port Inject Site Radiolucent Ndlless W/Safety Clamp Lf","code_information":[{"code":"7719894","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Ventilation 1.27Mm Sheehy Collar Button Fluoroplastic Ear","code_information":[{"code":"7719895","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 5Mm Protex Cannul","code_information":[{"code":"7719896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 380Mm 130Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719897","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7085.0,"discounted_cash":2834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Vasc Protege Everflex 6X40Mm 120Cm Slf-Expand 0.035In Gw 6Fr Sheath Entrust Spiral Cell","code_information":[{"code":"7719898","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4121.0,"discounted_cash":1648.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Wound Maxorb Extra Ag+Cmc 1X12In Flat Rope Antimic High Absorb Gelling Calcium Alginate","code_information":[{"code":"7719899","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dressing Hydrocol Exuderm Lp 4X4In Square Thin Absorb Lo-Pro Translucent Lf Strl","code_information":[{"code":"7719900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Spinal Cslp 4X12Mm Lck Self-Tap Cancell Ti Cervical Expans Ns","code_information":[{"code":"7719901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Cslp 4X14Mm Lck Self-Tap Cancell Ti Cervical Expans Ns","code_information":[{"code":"7719902","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3X12Mm Cervical Quick-Coupling Compress W/Stop Ss Ns","code_information":[{"code":"7719903","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":409.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3X14Mm Quick-Coupling Compress W/14Mm Stop Ss Ns","code_information":[{"code":"7719904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":409.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3X16Mm Bicortical Ss Ns","code_information":[{"code":"7719905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":409.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 9-Hole Active Compress Ti Ant Clavicle F/3.5Mm Screw","code_information":[{"code":"7719906","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X75Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7719907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.0,"discounted_cash":770.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Tendril Sdx 24Cm Atrial Strl","code_information":[{"code":"7719908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3506.0,"discounted_cash":1402.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Isoflex Atrial Ventric","code_information":[{"code":"7719909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3506.0,"discounted_cash":1402.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Abbrevo Tvt             Tvtoml","code_information":[{"code":"7719910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":4106.0,"discounted_cash":1642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Diapason 6X140Mm Strt Ti Ns","code_information":[{"code":"7719911","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":696.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 320Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719912","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7085.0,"discounted_cash":2834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Div Bard 8X90     089008","code_information":[{"code":"7719913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X40Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7719914","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 4 69Mm/44Mm 12.5Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7719915","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3712.0,"discounted_cash":1484.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Surg Scalpel Size 15","code_information":[{"code":"7719916","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Scalpel #10     70135710","code_information":[{"code":"7719917","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reload Staple Proximate Endo Linear Cutter 75Mm 3.8/1.5Mm Open/Closed Reg Tissue 4-Row Cam Close","code_information":[{"code":"7719918","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stapler Inter Proximate Endo Linear Cutter Reload 75Mm 3.85Mm Reg Tissue 4-Row 8-Firing Cam Close","code_information":[{"code":"7719919","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":670.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Lcp 170Mm 6-Hole Pre-Contoured Compress Lck Ss Rt Condylar Femur F/4.5Mm Screw Ns","code_information":[{"code":"7719920","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5266.0,"discounted_cash":2106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rasp Surg Wire Pass Podiatry Micro Med 9.5Mm Cross-Cutting Reciprocat Round Shank Sm Bone Ss","code_information":[{"code":"7719921","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719922","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7719923","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Toe Joint Reflexion Med Stem Cement Metatarsal","code_information":[{"code":"7719924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3438.0,"discounted_cash":1375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 8X27Mm Bln-Expand Mount Ss Common Ext Iliac Artery 0.035In Gw","code_information":[{"code":"7719925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4121.0,"discounted_cash":1648.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 20Mm               Tp-20","code_information":[{"code":"7719926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2.5X22Mm Screw Lck Perm Partial Thread Cocr Dist Radial Volar Blue Ns","code_information":[{"code":"7719927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Protector Extrem Heelmedix Advanced Heel Std 11-19In Calf 3-Hole Open End Inner Lining Pull Down","code_information":[{"code":"7719928","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Tracheobronch Covered Icast 7X38Mm 80Cm Cath Bln-Expand Pre-Mount Low-Cross Profile Ultra-Thin","code_information":[{"code":"7719929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":10092.0,"discounted_cash":4036.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Size B Unicompart High Flexion Zimaloy Lt Medial Rt Lat Knee","code_information":[{"code":"7719930","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12847.0,"discounted_cash":5138.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X18Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7719931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Hps 0.035X4In Kirschner Temp Partial Thread Ss F/2/2.4Mm Screw","code_information":[{"code":"7719932","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2/2.4X30Mm Thread Qr Cannul Manual W/6Mm Stop F/2Mm Screw","code_information":[{"code":"7719933","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Biliary Paramount Mini Gps 6X14Mm 80Cmx17Mm Bln Bln-Expand Mount Lo-Pro Ss 0.018In Gw","code_information":[{"code":"7719934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4121.0,"discounted_cash":1648.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 420Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7719935","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7085.0,"discounted_cash":2834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Variax 2X16Mm Lck Perm Cross Head Smooth Dist Radial Volar","code_information":[{"code":"7719936","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Ventilation 1.14Mm 9.1 Flange Richard Cohen Grommet Silicone T-Shaped Green","code_information":[{"code":"7719937","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Ventilation 1.14Mm Armstrong Grommet Type 1 Collar Button Fluoroplastic Ear Bevel F/Myringotomy","code_information":[{"code":"7719938","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.93,"discounted_cash":57.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Packing Nasal Merocel Kennedy Reg 3.5X1.2Cm 0.9Cm Sinus Compress Slimline-Profile String White","code_information":[{"code":"7719939","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Splint Nasal Doyle Ii Airway Integrate Ant Tip Hole Silicone Intranasal Septal","code_information":[{"code":"7719940","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Asr 300 56Mm Cementls Porous","code_information":[{"code":"7719941","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16307.0,"discounted_cash":6522.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Total Joint 12/14Mm Taper","code_information":[{"code":"7719942","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1158.0,"discounted_cash":463.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asr Xl 49Mm Unipol","code_information":[{"code":"7719943","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6513.0,"discounted_cash":2605.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Splint Nasal Aquaplast Ps Sm 1/16In Semi-Rigid Thermoplast Ivory Silver Mickey Mouse","code_information":[{"code":"7719944","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Splint Nasal Aquaplast Ps Lg 1/16In Thermoplast Ivory Silver Mickey Mouse","code_information":[{"code":"7719945","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Ortho Trigen 3.2Mm 100Mm Thread Ball Tip Ss F/Intramedullary Nail Strl Disp","code_information":[{"code":"7719946","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Asr 300 62Mm Cementls Porous","code_information":[{"code":"7719947","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16307.0,"discounted_cash":6522.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asr Xl 55Mm Unipol","code_information":[{"code":"7719948","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6513.0,"discounted_cash":2605.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Asr +5Mm Neck Unipol Adapt 12/14 Taper Hip","code_information":[{"code":"7719949","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1158.0,"discounted_cash":463.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Mallinckrodt Shiley Laser-Flex Basic Airway 6Mm Adult Oral Nasal Curve Dual Cuffed Murphy","code_information":[{"code":"7719950","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Et Laser-Shield Ii 31Fr 7X10.5Mm Oral Nasal Cuffed Laser-Resistant Pvc Lf Strl Disp","code_information":[{"code":"7719951","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Laser-Shield Ii 35Fr 8X11.5Mm Oral Nasal Cuffed Laser-Resistant Pvc Lf Strl Disp","code_information":[{"code":"7719952","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Mallinckrodt Shiley Ring-Adair-Elwyn 4Mmx17Fr Ped Oral Curve Uncuffed Murphy Eye Preform","code_information":[{"code":"7719953","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Mallinckrodt Hi-Lo Ring-Adair-Elwyn 4.5Mm Ped Oral Taper Cuffed Hi-Vol Low-Pressure Murphy","code_information":[{"code":"7719954","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Mallinckrodt Shiley Ring-Adair-Elwyn 5Mm Ped Oral Curve Cuffed Murphy Eye Preform W/Catheter","code_information":[{"code":"7719955","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Mallinckrodt Shiley Ring-Adair-Elwyn 5.5Mm Ped Oral Curve Cuffed Murphy Eye Preform","code_information":[{"code":"7719956","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X60Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7719957","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Full 180Mm 7-Hole Master Tab Ilizarov Taylor Spatial Frame Alum F/Foot Ankle","code_information":[{"code":"7719958","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3743.0,"discounted_cash":1497.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Shiley Taperguard Evac 6X9X280Mm 28.6Mm Cuff Subglottic Taper Cuffed Hi-Vol Low-Pressure","code_information":[{"code":"7719959","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Et Shiley Taperguard Evac 6.5X9.8X290Mm 20.6Mm Cuff Subglottic Taper Cuffed Hi-Vol Low-Pressure","code_information":[{"code":"7719960","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Extern Fixat 300Mm Thread Lg Bone Tibial Ilizarov Ss F/Foot Ankle System Ns","code_information":[{"code":"7719961","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Ilizarov 30Mm 5-Hole Conn Sm Bone Ss Ns Reus","code_information":[{"code":"7719962","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Laryngectomy Laryngoflex Size 7 7X260Mm Spiral Cuffed Hi-Vol Low-Pressure Wire Reinforc","code_information":[{"code":"7719963","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Laryngectomy Laryngoflex Size 8 8X260Mm Spiral Cuffed Hi-Vol Low-Pressure Wire Reinforc","code_information":[{"code":"7719964","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X8Mm Cruciform Head Lck Ti Self-Tap Violet F/Reconstruction Plate Cmf Ns","code_information":[{"code":"7719965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X10Mm Cruciform Head Lck Ti Self-Tap Purple F/Reconstruction Plate Cmf Ns","code_information":[{"code":"7719966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 2.4X12Mm Cruciform Head Lck Ti Self-Tap Purple F/Reconstruction Plate Cmf Ns","code_information":[{"code":"7719967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Prosthesis Penile Ams 800 61-70Cm H2O Reg Silicone Elastomer Conceal Bln Fluid-Filled Press","code_information":[{"code":"7719968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":6451.0,"discounted_cash":2580.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X14Mm Cruciform Head Lck Ti Self-Tap Purple F/Reconstruction Plate Cmf Ns","code_information":[{"code":"7719969","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X16Mm Cruciform Head Lck Ti Self-Tap Violet F/Reconstruction Plate Cmf Ns","code_information":[{"code":"7719970","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X18Mm Cruciform Head Lck Ti Self-Tap Purple F/Reconstruction Plate Cmf Ns","code_information":[{"code":"7719971","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 8X96Mm 12-Hole 2.4Mm Lck Ti Reconstruct F/2.4Mm Screw Mandibular Ns","code_information":[{"code":"7719972","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2757.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 214X44Mm 29-Hole Lt Angle Lck Ti Reconstruct F/2.4Mm Screw Mandibular Ns","code_information":[{"code":"7719973","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5497.0,"discounted_cash":2198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 214X44Mm 29-Hole Rt Angle Lck Ti Reconstruct F/2.4Mm Screw Mandibular Ns","code_information":[{"code":"7719974","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5497.0,"discounted_cash":2198.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Talar-Fit Lck Strl","code_information":[{"code":"7719975","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":843.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Talar-Fit 9Mm Soft Thread Ti Conical Subtalar F/Arthroereisis Strl","code_information":[{"code":"7719976","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5683.0,"discounted_cash":2273.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Lead Neurostim Interstim Octapol Foramen W/Ndl 2-9Cm Ground Pad Sheath Dilator Cable Intro","code_information":[{"code":"7719977","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.0,"discounted_cash":463.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Lead Neurostim Interstim 1.27Mmx33Cm Tined Pur Percutan Strt Mri-Cond Disp","code_information":[{"code":"7719978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":11200.0,"discounted_cash":4480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl 11X25X13Mm Peek Vertebral 4Deg Lordot Wedge","code_information":[{"code":"7719980","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11807.0,"discounted_cash":4722.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl 11X25X11Mm Peek Vertebral 4Deg Lordot Wedge - D","code_information":[{"code":"7719981","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11807.0,"discounted_cash":4722.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.3X14Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Stardrive","code_information":[{"code":"7719982","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Fecal Manage Dignishield Incontinence Kit W/Med Delivery Lf Ns","code_information":[{"code":"7719983","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":455.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Tricut 3.5Mm   1883504Hr Rotatable","code_information":[{"code":"7719984","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":252.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Rad 40 4.0Mm   1884006Hr Rotatable","code_information":[{"code":"7719985","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tubing Irrigat Straightshot Ent F/Xps Model","code_information":[{"code":"7719986","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Block Ent Netterville Phonoform Wedge Silicone Cnt","code_information":[{"code":"7719987","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Retractor Surg Kanguruweb Contour Disp","code_information":[{"code":"7719988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hook Retraction Lone Star Adson Dura 5Mm Lg Self-Retaining Sharp Elastic Stay Ss Strl Disp","code_information":[{"code":"7719989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Drain Flexima Apd 12Frx25Cm Pig Loop Reg Duromet Lck W/Metal/Flexible Stiffen Cann Glidex","code_information":[{"code":"7719990","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Drain Kit Tls 7Fr         6640","code_information":[{"code":"7719991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Tubing Admin Pump Infusion Smartsite 20Gtt 117In 28Ml Priming Std Bore 0.2Um Filter Non-Low Sorb","code_information":[{"code":"7719992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Femur Asr +8Mm Neck Unipol Adapt 12/14 Taper Hip","code_information":[{"code":"7719993","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1450.0,"discounted_cash":580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Flexhd Structural Thin 4X7Cm 0.4-0.8Mm Hydrat Acell Dermal Matrix","code_information":[{"code":"7719994","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Flexhd Structural Thin 2X4Cm 0.4-0.8Mm Hydrat Acell Dermal Matrix","code_information":[{"code":"7719995","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":295.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Zps 2.5X180Mm Tibial 3-Flute Qck-Conn W/Case Ss Ns","code_information":[{"code":"7719996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"K-Wire 1.6Mm        4901-16-15","code_information":[{"code":"7719997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Neurostimulator Implant Interstim 60X55Mm Single-Array Multiprogr In-Line Conn Ext Tunneler Auto","code_information":[{"code":"7719998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":36229.0,"discounted_cash":14491.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extension Neurostim Interstim 10Cm Quadripol In Line W/Tip Conn Boot Long/Short Stylet Strl Disp","code_information":[{"code":"7719999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":2045.0,"discounted_cash":818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sponge Surg Patty 0.5X3In Strung Xray Detect W/O Loop Cotton Lf Strl F/Neurological 10/Pk","code_information":[{"code":"7720000","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Variax 2.3X16Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7720001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Catheter Thrombect Cleaner Xt 6Frx9Mm Wire 65Cm Sm Vessel 1Pc Rotational Sinusoidal Mech","code_information":[{"code":"7720002","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2273.0,"discounted_cash":909.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Dressing Foam Invia Lg White W/3-Piece Retic Polyether Pur Hydrophob Strl","code_information":[{"code":"7720003","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Size F Unicompart High Flexion Zimaloy Lt Medial Rt Lat Knee","code_information":[{"code":"7720004","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12847.0,"discounted_cash":5138.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 6 10Mm Unicompart Pe Lt Medial Rt Lat","code_information":[{"code":"7720005","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6649.0,"discounted_cash":2659.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Cement C/R Primary Tritanium Cocr Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7720006","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9104.0,"discounted_cash":3641.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 11Mm Artic Surface C/R Convent Pe","code_information":[{"code":"7720007","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":1822.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 5 Univ Cement Primary Cocr F/Total Knee Arthropl Strl","code_information":[{"code":"7720008","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5601.0,"discounted_cash":2240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 38Mm 11Mm Asymm Pe Strl","code_information":[{"code":"7720009","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2441.0,"discounted_cash":976.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Device Thermoablation Adv 6Mm Endometrial F/Impedance Control Ablation Novasure Strl Disp","code_information":[{"code":"7720010","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3917.0,"discounted_cash":1566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Passer Suture Suturelasso Arthro 2.3Mm Shoulder 45Deg Lt Corkscrew Preload Rotator Cuff Stiff Shaft","code_information":[{"code":"7720011","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X120Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720012","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Array 5.5X100Mm Pre-Bent Smooth Ti","code_information":[{"code":"7720013","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":638.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 8X80Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720014","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Nanocross Elite Dilatat 2.5X120Mm 150Cm Otw Semi-Compli F/Pta Ultra Lo-Pro","code_information":[{"code":"7720015","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1552.0,"discounted_cash":620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 7X37Mm 80Cmx40Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7720016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5973.0,"discounted_cash":2389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 8X37Mm 80Cmx40Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7720017","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5973.0,"discounted_cash":2389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary Visi-Pro 9X37Mm 120Cm Bln-Expand 0.035In Gw","code_information":[{"code":"7720018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5973.0,"discounted_cash":2389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 7 Univ Cement Primary Cocr F/Total Knee Arthropl Strl","code_information":[{"code":"7720019","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5382.0,"discounted_cash":2152.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Bio-Intrafix 7-9X30Mm Tcp Pla Taper Thread Absorb F/Fastener Tibial Soft Tissue","code_information":[{"code":"7720020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheath Endo Bio-Intrafix Fastener 9X30Mm Absorb F/Acl Soft Tissue Tcp/Pla Tibial","code_information":[{"code":"7720021","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Peek           48355104 10 X 25 X4","code_information":[{"code":"7720022","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11807.0,"discounted_cash":4722.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat 155Mm Long Foot-Shaped Ilizarov Taylor Spatial Frame Alum Strl","code_information":[{"code":"7720023","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4410.0,"discounted_cash":1764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Full 155Mm 7-Hole Master Tab Ilizarov Taylor Spatial Frame Alum F/Foot Ankle","code_information":[{"code":"7720024","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3743.0,"discounted_cash":1497.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 60Mm Thread Slot Sm Bone Ilizarov Ss","code_information":[{"code":"7720025","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7720026","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Half Pin Extern Fixat 5Mm Short 110Mm 35Mm Thread Ankle Foot Jet-X Ss Ti Nitride Ns 71065351","code_information":[{"code":"7720027","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.1X98Mm 7-Hole Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic F/3.5Mm Screw","code_information":[{"code":"7720028","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":1829.0,"discounted_cash":731.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 7X60Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 10X40Mm 35Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720030","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Cath Brite Tip 11Fr Taper Dual Layer Slix Manicured W/Mini-Gw 45Mm Dilator 11Cm Silicone","code_information":[{"code":"7720031","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acutrak 2 Mini 3.5-3.6X24Mm Cannul Compress Headless Full Wide Thread Strl","code_information":[{"code":"7720032","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":624.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dvr 24.4X59.5Mm 4-Hole Short Timax Anatomic Std Rt Dist Volar Radial Ns","code_information":[{"code":"7720033","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2870.0,"discounted_cash":1148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Dvr 2.5Mmx4In Volar Qck-Conn Strl Disp F/Anatomic Plate System","code_information":[{"code":"7720034","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dvr 21.6X48.9Mm 4-Hole Short Narrow Timax Anatomic Rt Dist Volar Radial W/Fast Guide Ns","code_information":[{"code":"7720035","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2870.0,"discounted_cash":1148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Dvr 2X14Mm Lck Perm Round Smooth Cocr Dist Radial Volar Ns","code_information":[{"code":"7720036","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg,18Mm                   P18","code_information":[{"code":"7720037","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2Mm Long 20Mm Lck Perm Smooth Cocr Subchondral Volar Blue","code_information":[{"code":"7720038","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2Mm Long 22Mm Lck Perm Smooth Cocr Subchondral Volar Blue","code_information":[{"code":"7720039","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2Mm Long 24Mm Lck Perm Smooth Cocr Subchondral Volar Blue","code_information":[{"code":"7720040","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dvr 3.5X12Mm Full Thread Cortic Ti Cruciform Head Magenta Dist Volar Radial F/Anatomic","code_information":[{"code":"7720041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dvr 3.5X14Mm Full Thread Cortic Ti Cruciform Head Magenta Dist Volar Radial F/Anatomic","code_information":[{"code":"7720042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dvr 3.5X10Mm Full Thread Cortic Ti Cruciform Head Magenta Dist Volar Radial F/Anatomic","code_information":[{"code":"7720043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho T2 2.5Mm 800Mm Ball Tip Ti Humeral F/Intramedullary Nailing System Strl","code_information":[{"code":"7720044","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X16Mm Screw Lck Perm Round Full Thread Ti Dist Radial Volar F/Hand Frx","code_information":[{"code":"7720045","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2.5X18Mm Screw Lck Perm Partial Thread Cocr Dist Radial Volar Blue Ns","code_information":[{"code":"7720046","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X26Mm Screw Lck Perm Round Full Thread Ti Dist Radial Volar F/Hand Frx","code_information":[{"code":"7720047","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dvr 24.4X89.5Mm 7-Hole Timax Anatomic Extend Lt Dist Volar Radial W/Fast Guide Ns","code_information":[{"code":"7720048","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2870.0,"discounted_cash":1148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Fluid Warming Blood Ranger Hotline 39Ml Priming Iv Std Flow 2-Male Ll Conn Needle-Free Port","code_information":[{"code":"7720049","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sensor Pulse Ox Tfa-1 Lncs Adhes Ped Adult Forehead W/Headband Lf Ns Disp","code_information":[{"code":"7720050","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Spinal Protex 6X65Mm Curve Ti Thoracolum","code_information":[{"code":"7720051","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 3 Univ Cement Primary Cocr F/Total Knee Arthropl Strl","code_information":[{"code":"7720052","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5601.0,"discounted_cash":2240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 32Mm 10Mm Asymm Pe Strl","code_information":[{"code":"7720053","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2441.0,"discounted_cash":976.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 4 Cementls C/R Bead Tritanium Cocr Peri-Apatite Rt F/Total Knee","code_information":[{"code":"7720054","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14200.0,"discounted_cash":5680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2.5X26Mm Screw Lck Perm Partial Thread Cocr Dist Radial Volar Blue Ns","code_information":[{"code":"7720055","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2Mm Long 16Mm Screw Non-Locking Smooth Cocr Subchondral Blue","code_information":[{"code":"7720056","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2Mm Long 18Mm Screw Non-Locking Smooth Cocr Subchondral Blue","code_information":[{"code":"7720057","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Quick-Cross Support 0.039/0.026In P/D 135Cm 45Deg Angle Taper 15Mm Space Periph","code_information":[{"code":"7720058","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Guiding Quick-Cross Support 0.063/0.035In P/D 135Cm 45Deg Angle Taper 50Mm Space Periph","code_information":[{"code":"7720059","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acutrak 2 Mini 3.5-3.6X20Mm Cannul Compress Headless Full Wide Thread Strl","code_information":[{"code":"7720060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1450.0,"discounted_cash":580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak 2 2Mm Micro Mini Cervical Qr Profile Compress Ss Ns F/3.5-4Mm Headless Screw","code_information":[{"code":"7720061","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak 2 2.5Mm Micro Cervical Qr Profile Ss Ns F/Standard Bone Screw","code_information":[{"code":"7720062","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cartridge Suture Om-9044","code_information":[{"code":"7720063","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":266.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Phacoemulsification 0.9Mm Micro Abs Intrepid Balanced Tip W/0.9Mm Infusion Sleeve 30Bal","code_information":[{"code":"7720064","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Probe Vitrectomy Centurion Ultravit 23Ga Ant Assembly Strl F/Vision System","code_information":[{"code":"7720065","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Charlotte 3X30Mm Cannul Compress Headless Self-Tapping/Drilling Short Dual Lead Thread Ss","code_information":[{"code":"7720066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 36Mm +0Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7720067","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3734.0,"discounted_cash":1493.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size E 36Mm 54-56Mm 7.9Mm 10Deg Angle Primary X3 W/Hemispherical Shell","code_information":[{"code":"7720068","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4895.0,"discounted_cash":1958.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Bio-Intrafix 6-8X30Mm Tcp Pla Taper Thread Absorb F/Fastener 254623 Tibial Soft","code_information":[{"code":"7720069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 104Mm 6-Hole Pre-Contoured Lck Ss Fixed Angle Lt Lat Prox Tibial F/2.7/3.5Mm Screw Ns","code_information":[{"code":"7720070","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4325.0,"discounted_cash":1730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 400Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7720071","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7085.0,"discounted_cash":2834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ace Wrap Sterile   Dynj05158Lf 6 X 15 Yds","code_information":[{"code":"7720072","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bandage Compress Matrix Roll 4Inx5Yd Elastic Hk-Loop Self-Closure Beige White Cotton Pes Lf Strl","code_information":[{"code":"7720073","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Device Compress Safeguard 12Cm Press Assist Max Inflat Dressing Sp","code_information":[{"code":"7720074","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 4.5X55Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Polyax 3.2Mm Dist Femur Calib F/Locking Plate System","code_information":[{"code":"7720076","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X40Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7720077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X50Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7720078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.3X22Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7720079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho T2 +5X11.5Mm Ti Tibial F/Intramedullary Nail Strl","code_information":[{"code":"7720080","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Polyax 179.4Mm 6-Hole Lck Timax Lt Dist Femur Ns","code_information":[{"code":"7720081","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5255.0,"discounted_cash":2102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X45Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7720082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X80Mm Cannul Lck Full Thread Polyaxial Self-Tap Fixed Angle Cancell Ti Bullet","code_information":[{"code":"7720083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":373.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X30Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lens Intraocular 5.0 Diopter 13Mm Dia Biconvex Silicone","code_information":[{"code":"7720085","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Variax 73Mm 12-Hole 2Mm Long Univ Narrow Ti Polyaxial Dist Volar Radial F/2.7Mm Screw","code_information":[{"code":"7720086","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2580.0,"discounted_cash":1032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone T2 5X30Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7720087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Gamma3 4.2Mm Short 130Mm Femur Qck-Conn Ao Fit Calib Lf Strl Disp F/T2 R1.5 Nailing System","code_information":[{"code":"7720088","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7720089","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Baseplate Tibial Triathlon Size 4 Univ Cement Primary Cocr F/Total Knee Arthropl Strl","code_information":[{"code":"7720090","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5601.0,"discounted_cash":2240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cement Bone Palacos R+G 40Gm High Viscos Single-Dose Gentamicin","code_information":[{"code":"7720091","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1555.0,"discounted_cash":622.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 73Mm 6-Hole Sm Dynamic Compress Lck Ss Condylar F/3.5Mm Screw Ns","code_information":[{"code":"7720092","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 97Mm 8-Hole Sm Dynamic Compress Lck Ss Condylar F/3.5Mm Screw Ns","code_information":[{"code":"7720093","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dcp 121Mm 10-Hole Sm Dynamic Compress Lck Ss Condylar F/3.5Mm Screw Ns","code_information":[{"code":"7720094","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.7X125Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns F/Lcp Screw","code_information":[{"code":"7720095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.1X168Mm 12-Hole Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic F/3.5Mm","code_information":[{"code":"7720096","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2142.0,"discounted_cash":856.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.1X140Mm 10-Hole Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic F/3.5Mm","code_information":[{"code":"7720097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.0,"discounted_cash":785.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10X52Mm 3/3-Hole 1.5Mm T-Shaped Oblique Lt Angle Pre-Contoured Compress Lck Ss Std Rt","code_information":[{"code":"7720098","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":492.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10X63Mm 3/4-Hole 1.5Mm T-Shaped Oblique Lt Angle Pre-Contoured Compress Lck Ss Std Rt","code_information":[{"code":"7720099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10X74Mm 3/5-Hole 1.5Mm T-Shaped Oblique Angle Pre-Contoured Compress Lck Ss Std Lt","code_information":[{"code":"7720100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1341.0,"discounted_cash":536.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 96Mm 3/7-Hole T-Shaped Oblique Rt Angle Pre-Contoured Compress Lck Ss Prox Tibial","code_information":[{"code":"7720101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1469.0,"discounted_cash":587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 74Mm 3/5-Hole T-Shaped Oblique Rt Angle Pre-Contoured Compress Lck Ss Prox Tibial","code_information":[{"code":"7720102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1341.0,"discounted_cash":536.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 52Mm 3/3-Hole T-Shaped Oblique Rt Angle Pre-Contoured Compress Lck Ss Prox Tibial","code_information":[{"code":"7720103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1294.0,"discounted_cash":517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X18Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X22Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Dcp 2.7X24Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X26Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X28Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X30Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X32Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Dcp 2.7X34Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X36Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X38Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X40Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Dcp 2.7X45Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Dcp 2.7X50Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2.7X55Mm Compress Lck Full Thread Self-Tap Cortic Ss Hex Socket Spheric Head Radial","code_information":[{"code":"7720117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lc-Dcp 3.5X16Mm Shaft Dynamic Compress 10Mm Partial Thread Cortic Ss Hex Socket Spheric","code_information":[{"code":"7720118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lc-Dcp 3.5X24Mm Compress Lck Full Thread Slf-Tap Cortic Ss Hex Socket Spheric Head Dist-D","code_information":[{"code":"7720119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lc-Dcp 3.5X30Mm Shaft Dynamic Compress 10Mm Partial Thread Cortic Ss Hex Socket Spheric","code_information":[{"code":"7720120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lc-Dcp 3.5X36Mm Shaft Dynamic Compress 12Mm Partial Thread Cortic Ss Hex Socket Spheric","code_information":[{"code":"7720121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lc-Dcp 3.5X36Mm Shaft Dynamic Compress 12Mm Partial Thread Cortic Ss Hex Socket Spheric-D","code_information":[{"code":"7720122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Tibial Size 2 8Mm Unicompart Pe Rt Medial Lt Lat","code_information":[{"code":"7720123","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6649.0,"discounted_cash":2659.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 3.2Mm 400Mm Thread Ti F/Femoral Tibial Nail Ns","code_information":[{"code":"7720124","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Expert 4.2Mm Long 330Mm 100Mm Im Tibial 3-Flute Quick-Coupling Cannul Calib Ss Ns","code_information":[{"code":"7720125","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":314.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Expert 4.2X145Mm Im Tibial 3-Flute Quick-Coupling Calib Needle Point Green Ti Ns","code_information":[{"code":"7720126","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 116Mm 4-Hole Pre-Contoured Compress Lck Ss Rt Dist Medial Tibial F/3.5Mm Screw W/O","code_information":[{"code":"7720127","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5310.0,"discounted_cash":2124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 3X120Mm 135Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7720128","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Submarine Plus Dilatat 7X20Mm 90Cm","code_information":[{"code":"7720129","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1552.0,"discounted_cash":620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Submarine Plus Dilatat 3X20Mm 90Cm","code_information":[{"code":"7720130","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1552.0,"discounted_cash":620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Nanocross Elite Dilatat 2X80Mm 150Cm Otw Semi-Compli F/Pta Ultra Lo-Pro","code_information":[{"code":"7720131","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1552.0,"discounted_cash":620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Nanocross Elite Dilatat 3X80Mm 150Cm Otw Semi-Compli F/Pta Ultra Lo-Pro","code_information":[{"code":"7720132","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1552.0,"discounted_cash":620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vasc Protege Everflex 7X150Mm 120Cm Otw Slf-Expand Pre-Mount Nitinol Iliac Superficial","code_information":[{"code":"7720133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7419.0,"discounted_cash":2967.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Device Embolic Protect Spiderfx 6Mm Loop Otw/Rx Preload Braid Basket Carotid/Saphenous Vein W/Filter","code_information":[{"code":"7720134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 4X40Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720135","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Biliary Paramount Mini Gps 7X14Mm 80Cmx17Mm Bln Bln-Expand Mount Lo-Pro Ss 0.014In Gw","code_information":[{"code":"7720136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4121.0,"discounted_cash":1648.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 4 Cementls C/R Bead Tritanium Cocr Peri-Apatite Lt F/Total Knee","code_information":[{"code":"7720137","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14200.0,"discounted_cash":5680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 9Mm Artic Surface C/R Fixed Bearing X3 F/Total Knee Arthropl","code_information":[{"code":"7720138","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10137.0,"discounted_cash":4054.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Surg Ear Arrow Tip Flat Ss Pp Strl F/Myringotomy","code_information":[{"code":"7720139","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Patellar Triathlon 32Mm 10Mm Primary Asymm X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720140","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5030.0,"discounted_cash":2012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Protex 6X75Mm Curve Ti Thoracolum","code_information":[{"code":"7720141","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1038.0,"discounted_cash":415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Screwdriver Plusdrive 1.5X2X76Mm Cranfac Hex Coupl Self-Retaining Lf Ns F/2/2.4Mm Screw","code_information":[{"code":"7720143","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":674.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2Mm Long 26Mm Lck Perm Smooth Cocr Subchondral Volar Blue","code_information":[{"code":"7720144","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 47Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7720145","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2206.0,"discounted_cash":882.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Forceps Spec Retriev Endojaw Alligator Biopsy 7.2Mm Cup Open 230Cm Upper Gi W/Needle Blue Sheath Ss","code_information":[{"code":"7720146","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Anchor Suture Corkscrew 5X15.5Mm Thread Sharp Point Nonabsorbable W/#2 Braid Pe Cancell Ti","code_information":[{"code":"7720147","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":751.0,"discounted_cash":300.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X34Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.5X30Mm Lck Inter Captured Cortic Ti Hex Head Gray Im F/8.5Mm","code_information":[{"code":"7720149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 8.5Mm Std 320Mm Antegrade/Retrograde Femur Tibial Knee Ti Alloy Gray","code_information":[{"code":"7720150","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":2300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.5X40Mm Lck Inter Captured Cortic Ti Hex Head Gray Im F/8.5Mm","code_information":[{"code":"7720151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Hps 0.045X4In Kirschner Temp Single-Ended Thread Trocar Point Ss F/3/4Mm Screw","code_information":[{"code":"7720152","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X24Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720153","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Omnifit Torx 6.5X25Mm Ss Cancell Strl","code_information":[{"code":"7720154","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 11 17Mm Dist 51Mm Offst 170Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7720155","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15334.0,"discounted_cash":6133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Catheter Thoracentesis Plura-Seal Safety 8Frx4.75In Slf-Seal Vlv Sharp W/18Ga 19Cm Ndl 3-Way","code_information":[{"code":"7720157","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":649.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 6 Cementls C/R Bead Tritanium Cocr Peri-Apatite Rt F/Total Knee","code_information":[{"code":"7720158","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15334.0,"discounted_cash":6133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 6 Univ Cement Primary Cocr F/Total Knee Arthropl Strl","code_information":[{"code":"7720159","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5906.0,"discounted_cash":2362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 38Mm 11Mm Primary Asymm X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720160","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3318.0,"discounted_cash":1327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 3 Cementls Post Stabil Bead Tritanium Cocr Peri-Apatite Lt F/Total","code_information":[{"code":"7720161","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15493.0,"discounted_cash":6197.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 29Mm 9Mm Primary Asymm X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720162","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3318.0,"discounted_cash":1327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tobramycin Cement   6197-9-001 Tobramycin Cement Antibiotic","code_information":[{"code":"7720163","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2045.0,"discounted_cash":818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 36Mm -5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7720165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4781.0,"discounted_cash":1912.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trident Size F 56Mm Cluster-Hole Hemis Primary Modul Lck Pe","code_information":[{"code":"7720166","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5578.0,"discounted_cash":2231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Reflex Hybrid 4X14Mm Self-Drill Var Ang Pedicle Ti Blue Ant Cervical Sharp Tip","code_information":[{"code":"7720167","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.0,"discounted_cash":535.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X60Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720168","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 6X40Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720169","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 8X40Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720170","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Plain Gut 4-0 18In Strt Sc-1 Revers Cut Yellowish Tan 1 Strand/Pk 1824H Uni-Direct Monofil","code_information":[{"code":"7720171","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 4 Cement C/R Primary Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7720172","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9605.0,"discounted_cash":3842.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl 8X25X8Mm Peek Vertebral 4Deg Wedge","code_information":[{"code":"7720173","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12393.0,"discounted_cash":4957.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 7X40Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720174","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Peripheral Cutting Balloon Dilatat Scoring 6X20Mm 90Cm Otw Non-Compli F/Pta","code_information":[{"code":"7720175","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3302.0,"discounted_cash":1320.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Peripheral Cutting Balloon Dilatat Scoring 8X20Mm 90Cm Otw Non-Compli F/Pta","code_information":[{"code":"7720176","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3302.0,"discounted_cash":1320.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 8Mmx5Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":9209.0,"discounted_cash":3683.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 8Mmx10Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":11040.0,"discounted_cash":4416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 8Mmx15Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":12850.0,"discounted_cash":5140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Dilatat 5X8Mm 50Cm F/Pta Periph","code_information":[{"code":"7720180","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filter Vasc Eclipse Ivc 7Frx48Cm Nitinol F/Jugular/Subclavian Delivery","code_information":[{"code":"7720181","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":2300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 44Mm Unipol 12/14 Taper Primary Endoprosthesis Zimaloy Hip Strl","code_information":[{"code":"7720182","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2177.0,"discounted_cash":870.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Sheath 5Fr 402-605P Avanti, W/Guidewire, 5.5","code_information":[{"code":"7720183","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":26.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 7X80Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720184","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 8X80Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720185","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 6X20Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720186","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 7X20Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720187","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 8X20Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720188","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":422.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filter Vasc Eclipse Ivc 7Frx48Cm Nitinol F/Femoral Delivery","code_information":[{"code":"7720189","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5752.0,"discounted_cash":2300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 6Mmx5Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9209.0,"discounted_cash":3683.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 6Mmx10Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11040.0,"discounted_cash":4416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 6Mmx15Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12850.0,"discounted_cash":5140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 7Mmx5Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720193","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9209.0,"discounted_cash":3683.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 7Mmx10Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720194","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11040.0,"discounted_cash":4416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Endoprosthesis Graft Covered Viabahn 7Mmx15Cm 120Cm Cath Non-Compli Lo-Pro Bioactive Surface","code_information":[{"code":"7720195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12850.0,"discounted_cash":5140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 9Mm Std 345Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720196","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5476.0,"discounted_cash":2190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture #1 5X15.5Mm Cs W/Needle Fiberwire Strl","code_information":[{"code":"7720197","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X36Mm Cannul Full Thread Reduce Head Cancell Timax Ns","code_information":[{"code":"7720198","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Forceps Spec Retriev Endojaw Biopsy 5Mm Open Std 155Cm Lung Oval Green Sheath Ss Strl Disp 2Mm","code_information":[{"code":"7720199","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 4 Cement Post Stabil Tritanium Cocr Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7720200","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9704.0,"discounted_cash":3881.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 11Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720201","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6272.0,"discounted_cash":2508.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Triathlon Perm Modul Dist Femur","code_information":[{"code":"7720202","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2130.0,"discounted_cash":852.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2X140Mm 3-Flute Quick-Coupling Calib Ns","code_information":[{"code":"7720203","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X16Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X18Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Inner Shiley Size 8 8.5Mm Adult Flex Pvc Lf Dehp-Free Strl Disp F/Tracheostomy Tube 15Mm","code_information":[{"code":"7720206","type":"CDM"},{"code":"272","type":"RC"},{"code":"A4623","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ercp Balloon Olympus  B-230Q-A","code_information":[{"code":"7720207","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drain Wound J-Vac 15Frx1/8In Round End Perf W/Trocar Silicone Lf Strl","code_information":[{"code":"7720208","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 5 Cementls C/R Bead Tritanium Cocr Peri-Apatite Rt F/Total Knee","code_information":[{"code":"7720209","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15334.0,"discounted_cash":6133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Introducer 5In   041829","code_information":[{"code":"7720211","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trident Size E 54Mm Cluster-Hole Hemis Primary Modul Lck Solid Back Tritanium Hap","code_information":[{"code":"7720212","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5578.0,"discounted_cash":2231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X19Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7720213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":281.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Protex 7X35Mm Cannul Lck Polyaxial Self-Tap Non-Threaded Pedicle Ti","code_information":[{"code":"7720214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Drain Tls Y-Connector 5/Pk","code_information":[{"code":"7720215","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Aspirat Excelon 19Ga 1.8Mm Sheath 15Mm 130Cm Fused Hub X-Catheter Button Lock W/20Ml Syringe","code_information":[{"code":"7720216","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Hps 0.045X6In Kirschner Temp Single-Ended Thread Trocar Point Ss F/3/4Mm Screw","code_information":[{"code":"7720217","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.3Mm Cannul F/3/4Mm Screw","code_information":[{"code":"7720218","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Neurostimulator Implant Interstim Ii 0.028In 51X44X7.5Mm Dbl Trocar Point Spinal Cord","code_information":[{"code":"7720219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":36912.0,"discounted_cash":14764.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Programmer Neurostim Interstim Smart Implant Pt Multi Device W/Integrated Software","code_information":[{"code":"7720220","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":4716.0,"discounted_cash":1886.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Revere 6.5X40Mm Lck Polyaxial Thread Dbl Lead Pedicle Ti Post Thoracolum Top Load","code_information":[{"code":"7720221","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5564.0,"discounted_cash":2225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Spinal Revere Lck 1Lvl Ti Lumb F/Screw Set","code_information":[{"code":"7720222","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X75Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720223","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer 7Fr         6207-S5 Percutaneous Lead","code_information":[{"code":"7720224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X100Mm Strt Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720225","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1450.0,"discounted_cash":580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X85Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720226","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Transconnector Spinal Revere 48-61Mm Lo-Pro Adjust Ti T-Shaped F/5.5Mm Rod","code_information":[{"code":"7720227","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4741.0,"discounted_cash":1896.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cement Bone         6197 9 001 Simplex P With Tobramycin","code_information":[{"code":"7720228","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2045.0,"discounted_cash":818.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X65Mm Curve Non-Threaded Ti Alloy Thoracolum 124665","code_information":[{"code":"7720229","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Temno Semi-Automated 20Ga 15Cm Bevel Tip Adjust Echo Cm Depth W/19Ga 10Cm Intro Green","code_information":[{"code":"7720230","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Biopsy Temno Std Semi-Automated 18Ga 20Cm Bevel Tip Coaxial Compact Adjust Echo Mark Hndl","code_information":[{"code":"7720231","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Swan Sleeve Icu         Cc5280 80Cm Contamination Shield","code_information":[{"code":"7720232","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shaft Reamer Bixcut 8X448Mm Modif Trinkle Modul Hall Strl Disp","code_information":[{"code":"7720233","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Versanail 3.8Mm Long 6In Calib Ns","code_information":[{"code":"7720234","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":373.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Bio-Intrafix 8-10X30Mm Tcp Pla Taper Thread Absorb F/Fastener Tibial Soft Tissue","code_information":[{"code":"7720235","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7720236","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Nexgen Legacy Size Cd 3-4 10Mm Net Shape Lat Artic Surface Post Stabil Fixed Flexion","code_information":[{"code":"7720237","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2336.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X40Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720238","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 380Mm 130Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7720240","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7018.0,"discounted_cash":2807.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size D 32Mm 50-52Mm 5.9Mm 10Deg Angle Primary X3 W/Hemispherical Shell","code_information":[{"code":"7720241","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4836.0,"discounted_cash":1934.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 32Mm +0Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7720242","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2519.0,"discounted_cash":1007.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trident Size D 50Mm Cluster-Hole Hemis Primary Modul Lck Solid Back Tritanium Hap","code_information":[{"code":"7720243","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5578.0,"discounted_cash":2231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spheres Reflective Mrkr 41773K","code_information":[{"code":"7720244","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Headband Navigation Ref Disp","code_information":[{"code":"7720245","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 6 Cementls C/R Bead Tritanium Cocr Peri-Apatite Lt F/Total Knee","code_information":[{"code":"7720246","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15334.0,"discounted_cash":6133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Close Starclose Se Vasc W/Clip Applier 6Fr Exchange Sheath/Dilator 0.038 J-Tip Gw F/Femoral","code_information":[{"code":"7720247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.0,"discounted_cash":398.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Trident Size F 56Mm Cluster-Hole Hemis Primary Modul Lck Solid Back Tritanium Hap","code_information":[{"code":"7720248","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5578.0,"discounted_cash":2231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size F 40Mm 54-56Mm 7.9Mm 0Deg Angle Primary X3 Strl","code_information":[{"code":"7720249","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5079.0,"discounted_cash":2031.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 40Mm +0Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip","code_information":[{"code":"7720250","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7828.0,"discounted_cash":3131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 9 13Mm Dist 45Mm Offst 150Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7720251","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15334.0,"discounted_cash":6133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 5Mm Round Flute Aggress Cut Lf F/Elite Core Tps Saber Shank","code_information":[{"code":"7720252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg 6Mm Round Flute Aggress Cut F/Elite Core Tps Saber Shank","code_information":[{"code":"7720253","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X45Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720256","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Anchor Suture Rapidloc 12Deg Angle Curve Absorb W/#2/0 Long-Term Braid Panacryl Pds","code_information":[{"code":"7720257","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Anchor Suture Rapidloc 27Deg Angle Curve Absorb W/#2/0 Long-Term Braid Panacryl Pds","code_information":[{"code":"7720258","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Anchor Suture Rapidloc Strt Absorb W/#2/0 Long-Term Braid Panacryl Pds Tophat/Pla Backstop","code_information":[{"code":"7720259","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size F Cement Post Stabil Prolng Zimaloy Lt Lat Knee Strl","code_information":[{"code":"7720260","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17489.0,"discounted_cash":6995.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/5-6 14Mm Net Shape Lat Artic Surface Post Stabil Fixed Flexion","code_information":[{"code":"7720261","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5842.0,"discounted_cash":2336.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X28Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl 11X25X12Mm Peek Vertebral 4Deg Lordot Wedge","code_information":[{"code":"7720263","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11918.0,"discounted_cash":4767.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Joint Instrument 3.2Mm Long Flute Headless Lat","code_information":[{"code":"7720264","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1915.0,"discounted_cash":766.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size G Cement Post Stabil Prolng Zimaloy Rt Lat Knee Strl","code_information":[{"code":"7720265","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16817.0,"discounted_cash":6726.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X28Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7720266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X34Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7720267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X26Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7720268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X28Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7720269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X32Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7720270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X14Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Reflex 48Mm 8-Hole 2.1Mm Lo-Pro Lck Hybrid 3Lvl 1-Step Ti Curve Contour Ant Cervical","code_information":[{"code":"7720272","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5882.0,"discounted_cash":2352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 4 8Mm Unicompart Pe Rt Medial Lt Lat","code_information":[{"code":"7720273","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5492.0,"discounted_cash":2196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drain Total Abscession Gen 8Frx30Cm Pig 6Sh Mp Mold Tip Hub Vault Lock Link-Resistant Blue","code_information":[{"code":"7720274","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Drain Total Abscession Gen 10Frx30Cm Pig 6Sh Mp Mold Tip Hub Vault Lock Blue Lf Strl","code_information":[{"code":"7720275","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Drainage     14000805 12 Fr X 30 Cm","code_information":[{"code":"7720276","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Aspirat Excelon 21Ga 1.8Mm Sheath 15Mm 130Cm Fused Hub X-Catheter Button Lock W/20Ml Syringe","code_information":[{"code":"7720277","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Vicryl 4-0 Fs-1   J441H","code_information":[{"code":"7720278","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trident Size E 52Mm Cluster-Hole Hemis Primary Modul Lck Solid Back Tritanium Hap","code_information":[{"code":"7720279","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5367.0,"discounted_cash":2146.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Nester 4Mmx14Cm Pushable 11.1-Loop Synthetic Fiber Platin Mri-Cond 0.035In Cath","code_information":[{"code":"7720280","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Agent Hemostat Porcine Gelatin Matrix Absorb Surgiflo Flexi Tip Prefilled 2Yr Shelf Life","code_information":[{"code":"7720281","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Variax 2.3X14Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7 Ns","code_information":[{"code":"7720282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 35Mm 10Mm Primary Asymm X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720284","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1088.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 3 Cementls C/R Bead Tritanium Cocr Peri-Apatite Lt F/Total Knee","code_information":[{"code":"7720285","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12569.0,"discounted_cash":5027.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Xia Ii 7.5X40Mm Open Polyaxial Cort/Canc Pedicle Ti 60Deg Green 50Deg Angle Top","code_information":[{"code":"7720286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3906.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 7.5 X 35 Mm     03821735","code_information":[{"code":"7720287","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3906.0,"discounted_cash":1562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys Size 13 138Mm Cementls Primary Std Offst Collarls Trabecul Metal Tivanium Porous","code_information":[{"code":"7720288","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":22665.0,"discounted_cash":9066.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 36X60Mm Std 9.9Mm Neutral 0Deg Angle Full Hemis Primary Modul Longevity Xl","code_information":[{"code":"7720289","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5714.0,"discounted_cash":2285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drain Wound 7Frx1/8In Round End Perf W/Adapter W/O Trocar Silicone Lf Strl Jp","code_information":[{"code":"7720290","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Ring Retractor Lone Star 28.3X18.3Cm Plastic Noryl Resin Disp","code_information":[{"code":"7720291","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Groningen Voice Button   Gh-07 Low Pressure Size 7","code_information":[{"code":"7720292","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":371.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Groningen Voice Button   Gh-08 Low Pressure Size 8","code_information":[{"code":"7720293","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":371.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size E Cement Post Stabil Prolng Zimaloy Rt Lat Knee Strl","code_information":[{"code":"7720294","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16817.0,"discounted_cash":6726.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Tibial Nexgen Taper Stem Knee F/Prosthesis","code_information":[{"code":"7720295","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2774.0,"discounted_cash":1109.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/5-6 17Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720296","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6293.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 40Mm -2.5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip","code_information":[{"code":"7720297","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3917.0,"discounted_cash":1566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Reflex 14Mm 4-Hole 2.1Mm Lo-Pro Lck Hybrid 1Lvl 1-Step Ti Curve Contour Ant Cervical","code_information":[{"code":"7720299","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":1736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 7 Cementls C/R Bead Tritanium Cocr Peri-Apatite Rt F/Total Knee","code_information":[{"code":"7720300","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12569.0,"discounted_cash":5027.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/3-4 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720301","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6293.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X40Mm Cannul Lag Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":245.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 41Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7720303","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2319.0,"discounted_cash":927.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 51Mm Head Std 190Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7720304","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2319.0,"discounted_cash":927.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon Endo Ultrasound Applicator F/Bf-Uc16F Ebus Bronchoscope Ltx Strl","code_information":[{"code":"7720305","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Needle Aspirat Vizishot Ebus 22Ga 40Mm 70Cm Adult Echo Tip W/5-Lockable Syringe 5-Valve F/Endo","code_information":[{"code":"7720306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":122.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Spinal Reflex Hybrid 4X12Mm Self-Drill Var Ang Pedicle Ti Blue Ant Cervical Sharp Tip","code_information":[{"code":"7720307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":426.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Cementls C/R Bead Rt","code_information":[{"code":"7720308","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14015.0,"discounted_cash":5606.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Plain Gut #0 27In 1/2 Circ Ct-1 Taper Point Yellowish Tan 1 Strand/Pk 844H Uni-Direct Monofil","code_information":[{"code":"7720309","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Spinal Reflex 57Mm 8-Hole 2.1Mm Lo-Pro Lck Hybrid 3Lvl 1-Step Ti Curve Contour Ant Cervical","code_information":[{"code":"7720310","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4899.0,"discounted_cash":1959.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 6 8Mm Unicompart Pe Rt Medial Lt Lat","code_information":[{"code":"7720311","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5492.0,"discounted_cash":2196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 10 14Mm Dist 46Mm Offst 160Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7720312","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12569.0,"discounted_cash":5027.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Dynaflo 8Mmx80Cm Strt Flex Sm Bead Preform Cuff Extern Spiral Support Carbon Eptfe Periph","code_information":[{"code":"7720313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8317.0,"discounted_cash":3326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Distaflo 1X7Mmx70Cm 25Cm Dist Strt Flex Sm Bead Std Cuff Extern Spiral Support Carbon","code_information":[{"code":"7720314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":7116.0,"discounted_cash":2846.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Distaflo 1X6Mmx80Cm 25Cm Dist Strt Flex Sm Beading/Cuff Extern Spiral Support Carbon","code_information":[{"code":"7720315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8634.0,"discounted_cash":3453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Generator Pacemaker Victory Xl Dr Implant 2-Chamber Rate Respons","code_information":[{"code":"7720316","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":26562.0,"discounted_cash":10624.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Tendril St Optim Bipol 6Frx58Cm 10Mm Space Rt Atrial Strt Steroid Elut Active Ext/Ret","code_information":[{"code":"7720317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3766.0,"discounted_cash":1506.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Safesheath 7Frx13Cm 20Cm Tearaway Vlv Sidept","code_information":[{"code":"7720319","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Prosthesis Penile Ams 700 3Cm Saline-Filled 2Pc Inflate Pre-Connected Accessory Scrotal Cylindr","code_information":[{"code":"7720320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1790.0,"discounted_cash":716.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reservoir Prosthesis Ams 700 65Ml Parylene Coat Saline-Filled Inflate Pre-Connected Scrotal Spheric","code_information":[{"code":"7720321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":5350.0,"discounted_cash":2140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pump Penile Ams 700 Lgx 12Mmx18Cm Saline-Filled Inflate Pre-Connected Penoscrotal Cylindr","code_information":[{"code":"7720322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":26468.57,"discounted_cash":10587.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Antenna Sacral Nerve     37092","code_information":[{"code":"7720323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2X18Mm Cannul Lag Headed Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2X22Mm Cannul Lag Headed Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Hps 0.035X4In Kirschner Temp Single-Ended Smooth Thread Trocar Point Ss F/2/2.4Mm","code_information":[{"code":"7720326","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Performa 6Frx125Cm Mp A2 Spx2 Wing Hub Pebax Nylon 0.038In Gw","code_information":[{"code":"7720327","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 2.8X300Mm Steinmann Temp Thread Ss","code_information":[{"code":"7720328","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Catheter Hemodialysis Arrow Cannon Ii Plus Smart Seal Chronic 15Frx24Cm 19Cm Tip To Cuff 2Lumen","code_information":[{"code":"7720329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":602.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Nexgen Legacy Size E 68/61.5Mm Cement Post Stabil Zimaloy Non-Porous Lt Lat Strl","code_information":[{"code":"7720330","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11302.0,"discounted_cash":4520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Hps 0.045X6In Kirschner Temp Partial Thread Ss F/3/4Mm Screw","code_information":[{"code":"7720331","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X14Mm Non-Cannulated Lck Self-Tap Fixed Angle Cortic Ss Periarticular Elbow W/2.7Mm","code_information":[{"code":"7720332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2X16Mm Cannul Lag Headed Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720333","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 4 Cementls C/R Bead Rt","code_information":[{"code":"7720334","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10233.0,"discounted_cash":4093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/1-2 12Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720335","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6293.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Memorygel 14.6Cm 6.7Cm 700Ml Silicone Gel Smooth Inject Dome Round W/Ss Conn Radovan","code_information":[{"code":"7720336","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2183.0,"discounted_cash":873.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Reflex 30Mm 6-Hole 2.1Mm Lo-Pro Lck Hybrid 2Lvl 1-Step Ti Curve Contour Ant Cervical","code_information":[{"code":"7720337","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4556.0,"discounted_cash":1822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 7 Cementls C/R Bead Rt","code_information":[{"code":"7720338","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10233.0,"discounted_cash":4093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 9Mm Artic Surface C/R Fixed Bearing X3 F/Total Knee Arthropl","code_information":[{"code":"7720339","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":2191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 40Mm 11Mm Primary Asymm X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720340","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1088.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trident Size F 58Mm Hemis Primary Modul Lck Solid Back Tritanium Hap","code_information":[{"code":"7720341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4574.0,"discounted_cash":1829.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Hip Cement Omnifit 9Mm Univ Centralizer Dist Femur Strl","code_information":[{"code":"7720342","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 40Mm 2.5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip","code_information":[{"code":"7720343","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3917.0,"discounted_cash":1566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Reflex 32Mm 6-Hole 2.1Mm Lo-Pro Lck Hybrid 2Lvl 1-Step Ti Curve Contour Ant Cervical","code_information":[{"code":"7720344","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4556.0,"discounted_cash":1822.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Bit 2.7Mm    2360-205-27","code_information":[{"code":"7720345","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":345.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 1.6Mm Std Drill Tip Ss F/Periarticular Lck Instrument Set Ns","code_information":[{"code":"7720346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1256.0,"discounted_cash":502.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Surg Prep Clipper W/Pivoting Assembly Head Type Purple Lf Disp F/Remington 9661","code_information":[{"code":"7720347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Urethral Bardex Foley 24Fr 5Ml Bln Ped Short Round Tip 2-Way 2-Opposing Drain Eye Silicone","code_information":[{"code":"7720348","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/3-4 12Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720349","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 82Mm 6-Hole Buttress Ss Rt Medial Prox Tibial F/3.5/4Mm Cort/Canc Screw Strl","code_information":[{"code":"7720350","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2787.0,"discounted_cash":1114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X40Mm Non-Cannulated Lck Full Thread Self-Tap Cortic Ss Conical Ns","code_information":[{"code":"7720351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X50Mm Non-Cannulated Lck Full Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7720352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X75Mm Cannul Lck Full Thread Self-Tap Cortic Ss Conical Periarticular Elbow","code_information":[{"code":"7720353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Gender Solutions Nexgen Lps-Flex Size F Post Stabil Specific Zimaloy Pmma Rt Strl","code_information":[{"code":"7720354","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17656.0,"discounted_cash":7062.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/5-6 12Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7720356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Nexgen Legacy Size E 68/61.5Mm Cement Post Stabil Zimaloy Non-Porous Rt Lat Strl","code_information":[{"code":"7720357","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11866.0,"discounted_cash":4746.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 11Mm Std 360Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720358","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5261.0,"discounted_cash":2104.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reservoir Prosthesis Ams 700 100Ml Parylene Coat Saline-Filled Inflate Pre-Connected Scrotal Cylindr","code_information":[{"code":"7720359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":5350.0,"discounted_cash":2140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pump Penile Ams 700 12Mmx21Cm Saline-Filled Control Expans Inflate Pre-Connected Penoscrotal Cylindr","code_information":[{"code":"7720361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":24940.0,"discounted_cash":9976.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/3-4 12Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720362","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size G 40Mm 58-60Mm 7.4Mm 0Deg Angle Primary X3 Strl","code_information":[{"code":"7720363","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4329.0,"discounted_cash":1731.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 5X250Mm Conn Hoffmann Ii Compact Yellow Carbon Fiber Mri-Safe","code_information":[{"code":"7720364","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Nubone 1Ml Dbm","code_information":[{"code":"7720365","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":338.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 6.5X40Mm       0382-1640","code_information":[{"code":"7720366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Citadel 22Mm Temp","code_information":[{"code":"7720367","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":299.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 3 Cementls C/R Bead Lt","code_information":[{"code":"7720369","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10233.0,"discounted_cash":4093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 3 11Mm Artic Surface C/R Fixed Bearing X3 F/Total Knee Arthropl","code_information":[{"code":"7720370","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5479.0,"discounted_cash":2191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade 4Mm Serrated  1884002Hre For Dr Sutton","code_information":[{"code":"7720371","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drain Yueh Centesis 5Frx15Cm Strt 4Sp Pig Loop 5-Lumen W/19Ga Hollow Needle Ss Nylon","code_information":[{"code":"7720372","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im T2 10Mm Std 315Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720373","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5261.0,"discounted_cash":2104.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Reflex Hybrid 4.5X14Mm Self-Tap Var Ang Pedicle Ti Green Ant Cervical Cut Flute Less","code_information":[{"code":"7720374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1416.0,"discounted_cash":566.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Bar To Bar      71064002","code_information":[{"code":"7720375","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2281.0,"discounted_cash":912.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat 10.5X400Mm Sm Bone Jet-X Carbon Fiber Ns Disp","code_information":[{"code":"7720376","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1010.0,"discounted_cash":404.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat T2 Recon 3.2X400Mm Kirschner Temp Quick-Coupling Shaft Cocr W/Washer Strl","code_information":[{"code":"7720377","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1X44.5Mm Cmf J-Latch Coupl W/4Mm Stop Ss Ns F/Lcp Modul Hand System","code_information":[{"code":"7720378","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl 11X25X11Mm Peek Vertebral 4Deg Lordot Wedge","code_information":[{"code":"7720379","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9276.0,"discounted_cash":3710.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X42Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7720380","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3144.0,"discounted_cash":1257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Cementls C/R Bead Lt","code_information":[{"code":"7720381","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12004.0,"discounted_cash":4801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X32Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720382","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Bar To Pin      71064001","code_information":[{"code":"7720383","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2281.0,"discounted_cash":912.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 4 Cementls C/R Bead Lt","code_information":[{"code":"7720384","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12004.0,"discounted_cash":4801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Bone Biopsy Size 2 Kyphon Express","code_information":[{"code":"7720385","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 6 Cementls C/R Bead Lt","code_information":[{"code":"7720386","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12004.0,"discounted_cash":4801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 6 Cementls C/R Bead Rt","code_information":[{"code":"7720387","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12004.0,"discounted_cash":4801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 11Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720388","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6910.0,"discounted_cash":2764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pacemaker Cardiac Symphony 2-Chamber Rate Respons Is-1 Conn","code_information":[{"code":"7720389","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":22546.0,"discounted_cash":9018.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 7 Cementls C/R Bead Lt","code_information":[{"code":"7720390","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12004.0,"discounted_cash":4801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/3-4 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720391","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7720392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Stent Vasc Protege Everflex 8X20Mm 80Cm Otw Slf-Expand Pre-Mount Nitinol Iliac Superficial","code_information":[{"code":"7720393","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3965.0,"discounted_cash":1586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 8X17Mm 80Cmx20Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7720394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3965.0,"discounted_cash":1586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 8X20Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720395","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Affixus 3Mm 100Cm Ball Nose F/Hip Frx Nail System","code_information":[{"code":"7720396","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Citadel 22Mmx1/4In Qck-Conn","code_information":[{"code":"7720397","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1296.0,"discounted_cash":518.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Unitrax V40 +0Mm Neck Unipol Adjust C-Tapered 5Deg Primary Modul Hip","code_information":[{"code":"7720398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Accuflex 6.5X45Mm","code_information":[{"code":"7720399","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5133.0,"discounted_cash":2053.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Neurostim Elapass Rj Bipol Is-1 Conn","code_information":[{"code":"7720400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1779","type":"HCPCS"}],"standard_charges":[{"gross_charge":2776.0,"discounted_cash":1110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Neurostim Elapass R Bipol Is-1 Conn","code_information":[{"code":"7720401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1779","type":"HCPCS"}],"standard_charges":[{"gross_charge":2776.0,"discounted_cash":1110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size G Cement Post Stabil Prolng Zimaloy Lt Lat Knee Strl","code_information":[{"code":"7720402","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17656.0,"discounted_cash":7062.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Gh/7-10 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720403","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Elapass P Bipol Rt Ventricle Is-1 Conn W/Tines Fixat","code_information":[{"code":"7720404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2776.0,"discounted_cash":1110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Elapass Pj Bipol Rt Atrium Is-1 Conn W/Tines Fixat","code_information":[{"code":"7720405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2776.0,"discounted_cash":1110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Cement Post Stabil Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7720406","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9327.0,"discounted_cash":3730.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 9Mm Artic Surface Post Stabil Bearing Uhmwpe Strl","code_information":[{"code":"7720407","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4578.0,"discounted_cash":1831.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Versanail 2.9Mmx6In Calib Ns","code_information":[{"code":"7720408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Versanail 7Mm Univ 260Mm Cannul Lck Humeral Ti Alloy Strl","code_information":[{"code":"7720409","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5904.0,"discounted_cash":2361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versanail 3.5X34Mm Non-Locking Full Thread Solid Cortic Hex Prox Humeral F/8Mm Nail 2.9Mm","code_information":[{"code":"7720410","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X38Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":299.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X26Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 11 15Mm Dist 51Mm Offst 170Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7720414","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14744.0,"discounted_cash":5897.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/5-6 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720415","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Gore-Tex 12X6Mmx40Cm Std Trunk Thin-Wall Limb Bifurc Non-Porous Eptfe Aorta F/Bypass","code_information":[{"code":"7720416","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3840.0,"discounted_cash":1536.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 11Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720417","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6910.0,"discounted_cash":2764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Talar-Fit 10Mm Soft Thread Ti Conical Subtalar F/Arthroereisis Strl","code_information":[{"code":"7720418","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4954.0,"discounted_cash":1981.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X120Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7720419","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Arthro 1.6Mmx14In Trocar Tip F/Advantage Profile Badv Interference Screw Reconstruct Ss","code_information":[{"code":"7720420","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 11Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720421","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":2195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Nexgen 12X100Mm 145Mm Strt Pre-Coated Offst Flute Sharp Solid Tivanium Tibial Knee","code_information":[{"code":"7720422","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3654.0,"discounted_cash":1461.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/3-4 66Mm/42Mm 12Mm Net Shape Lt Rt Condylar Knee Artic Surface","code_information":[{"code":"7720423","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6249.0,"discounted_cash":2499.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/3-4 14Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720424","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Assembly Fixat Stabil Pelvic Fine Wire Lf Ns Disp F/Tong","code_information":[{"code":"7720425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":18989.0,"discounted_cash":7595.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Polyloop            Hx-400U-30 Single Use Ligating Device","code_information":[{"code":"7720426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Basket Stone Retriev Zero-Tip 2.4Frx12Mm Sheath 120Cm Ureteral Helical Tip 4-Wire Detach Hndl","code_information":[{"code":"7720427","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":809.0,"discounted_cash":323.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Ortho Versanail Endo Gia 2Mm Univ 70Cm Ball Nose Humeral F/Intramedullary Nailing System","code_information":[{"code":"7720428","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Versanail 2.9Mm Short 6In Calib Ns","code_information":[{"code":"7720429","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial Lcs Complete Size 7 Cementls Stemmed Post Stabil Keeled Tricompart Mobile","code_information":[{"code":"7720430","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8424.0,"discounted_cash":3369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size F 72/65.5Mm Cement Post Stabil Zimaloy Non-Porous Lt Lat Strl","code_information":[{"code":"7720431","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11866.0,"discounted_cash":4746.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/7-10 12Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720432","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Citadel 72Mm Lo-Pro 2Lvl Ti Ant Lumbosacral","code_information":[{"code":"7720433","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19953.0,"discounted_cash":7981.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Citadel 6.5X24Mm Self-Tap Var Ang Ti Ant Lumb Streamlined Ns","code_information":[{"code":"7720434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2857.0,"discounted_cash":1142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X46Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X48Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720436","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Cover Or Position Kneegrip Moisture Wicking W/8In Upright/Foot Support Lf Disp","code_information":[{"code":"7720437","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Syringe Med Deflux 1Ml Cap Prefilled Gel","code_information":[{"code":"7720438","type":"CDM"},{"code":"272","type":"RC"},{"code":"L8603","type":"HCPCS"}],"standard_charges":[{"gross_charge":5152.0,"discounted_cash":2060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Syringe Med Deflux 1Ml Cap W/Needle 23Ga 350Mm","code_information":[{"code":"7720439","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Secur-Fit Plus Max Size 8 12Mm Dist 40Mm Offst 140Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7720440","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14744.0,"discounted_cash":5897.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 40Mm +7.5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip","code_information":[{"code":"7720441","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4595.0,"discounted_cash":1838.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X16Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X20Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X22Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":247.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X20Mm Cannul Lag Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Talar-Fit 12Mm Soft Thread Ti Conical Subtalar F/Arthroereisis Strl","code_information":[{"code":"7720446","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5152.0,"discounted_cash":2060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Talar-Fit 8Mm Soft Thread Ti Conical Subtalar F/Arthroereisis Strl","code_information":[{"code":"7720447","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5152.0,"discounted_cash":2060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X70Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7720448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stapler Inter Proximate Endo Linear Cutter Reload 100Mm 4.5Mm Thk Tissue 4-Row 8-Firing Cam Close","code_information":[{"code":"7720449","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":404.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reload Staple Proximate Endo Linear Cutter 100Mm 4.5/1.5Mm Open/Closed Thk Tissue 4-Row Cam Close","code_information":[{"code":"7720450","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Baseplate Tibial Triathlon Size 7 Cement Primary Bead Cocr Knee","code_information":[{"code":"7720451","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7382.0,"discounted_cash":2952.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 13Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720452","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6910.0,"discounted_cash":2764.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Evacuator Drain Novoplus Three Spring 1/8In 400Ml Round 12In Hole Pattern W/Trocar Y-Connector","code_information":[{"code":"7720453","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":52.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Xpeedior Thrombectomy Set Ultra               105040-001","code_information":[{"code":"7720454","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4815.0,"discounted_cash":1926.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Thromb Set Spiroflex-Vg                     106608-001","code_information":[{"code":"7720455","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":6914.0,"discounted_cash":2765.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spiroflex Thrombectomy Set Ultra               106553-001","code_information":[{"code":"7720456","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7309.0,"discounted_cash":2923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Avx Thrombectomy Set Ultra                     105039-001","code_information":[{"code":"7720457","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":2776.0,"discounted_cash":1110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Paste Bone Graft Intergro 1Ml Syringe Dbm W/Luer/Nozzle Cap Ext","code_information":[{"code":"7720458","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":248.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Citadel 28Mm Lo-Pro 1Lvl Ti Ant Lumbosacral","code_information":[{"code":"7720459","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18053.0,"discounted_cash":7221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 9Mm Std 360Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720460","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5625.0,"discounted_cash":2250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft E-Z Fil 5060050 78052","code_information":[{"code":"7720461","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7725.0,"discounted_cash":3090.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/5-6 14Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720462","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size F Cement Post Stabil Prolng Zimaloy Rt Lat Knee Strl","code_information":[{"code":"7720463","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17656.0,"discounted_cash":7062.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 2 Univ Cement Primary Cocr F/Total Knee Arthropl Strl","code_information":[{"code":"7720464","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5681.0,"discounted_cash":2272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Fios Bladeless Optical 15X100Mm Z-Threaded Sleeve Blunt Tip Strl Abdomin","code_information":[{"code":"7720465","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs As 14X12X7Mm Peek Cervical 4Deg Wedge","code_information":[{"code":"7720466","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6423.0,"discounted_cash":2569.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Compress Device Garment Hemo-Force Ii Reg Med 0-13In Instep Foot Color-Cd Single-Bladder","code_information":[{"code":"7720467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Compress Device Garment Hemo-Force Ii Lg 13-16In Instep Foot Color-Cd Single-Bladder Tubing","code_information":[{"code":"7720468","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Polyax 4X70Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cancell Ti Bullet Shape Tip","code_information":[{"code":"7720469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Compress Device Garment Hemo-Force Ii Reg Med 12-18In Calf Color-Cd Single-Bladder Tubing","code_information":[{"code":"7720470","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Polyax 5.5X70Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7720471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Compress Device Garment Hemo-Force Ii Lg 18-22In Calf Color-Cd Single-Bladder Tubing Exit","code_information":[{"code":"7720472","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Polyax 5.5X75Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7720473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Compress Device Garment Hemo-Force Ii Xl 22-32In Calf Bariatric Color-Cd Single-Bladder","code_information":[{"code":"7720474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Compress Device Garment Hemo-Force Ii Reg Med 22-29In Thigh Blue Gray Single-Bladder Tubing","code_information":[{"code":"7720475","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Compress Device Garment Hemo-Force Ii Lg 29-36In Thigh Color-Cd Single-Bladder Tubing Exit","code_information":[{"code":"7720476","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Trephine Surg Lg Cannul F/Lag Screw","code_information":[{"code":"7720477","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Xia Ii 5.5X40Mm Open Polyaxial Cort/Canc Pedicle Ti 60Deg Blue 50Deg Angle Top -D","code_information":[{"code":"7720478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4101.0,"discounted_cash":1640.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Bone Cement W/Curette Cup Pressurizer","code_information":[{"code":"7720479","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs As 14X12X8Mm Peek Cervical 4Deg Wedge","code_information":[{"code":"7720480","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6423.0,"discounted_cash":2569.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 10Mm Std 345Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720481","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5625.0,"discounted_cash":2250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Marker Breast Biopsy Ultraclip Ii 17Ga 3Mm Clip 10Cm Needle Ribbon-Shaped Ultrasound Enhanc Ti","code_information":[{"code":"7720482","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Biopsy Monopty 16Ga 9Cm 11Mm Penetr Auto Soft Tissue Bevel Sharp Trocar Tip Twist Hndl","code_information":[{"code":"7720483","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Truguide 15Ga 7.8Cm Depth Stop Purple F/Max-Core Mission/Monopty Instrument Soft","code_information":[{"code":"7720484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Citadel 75Mm Lo-Pro 2Lvl Ti Ant Lumbosacral","code_information":[{"code":"7720485","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19953.0,"discounted_cash":7981.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 6X80Mm 50Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":407.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 16.5Cm 3.7Cm Moderate-Profile 600Ml Silicone Gel Smooth Ant","code_information":[{"code":"7720487","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3371.0,"discounted_cash":1348.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trident Size G 62Mm Cluster-Hole Hemis Primary Modul Lck Solid Back Tritanium Hap","code_information":[{"code":"7720488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5526.0,"discounted_cash":2210.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Generator Pacemaker Zephyr Sr Implant 7.9Ml Single-Chamber Rate Respons Strl Ppm","code_information":[{"code":"7720489","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":20736.0,"discounted_cash":8294.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Vitoss 25X100X4Mm Substitute Foam 10Ml Resorb Preform Compress Resist Flex B-Tcp","code_information":[{"code":"7720490","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6559.0,"discounted_cash":2623.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Vitoss 25X100X8Mm Substitute Foam 20Ml Resorb Preform Compress Resist Flex B-Tcp","code_information":[{"code":"7720491","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11899.0,"discounted_cash":4759.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Bone Marrow Aspirat Imbibe 8Ga 8In Bullet Tip Fenes Strl","code_information":[{"code":"7720492","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":700.0,"discounted_cash":280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Syringe Bone Marrow Aspirat Imbibe 30Ml Bevel Tip Calib Ll Nozzle Screw Cap Pp","code_information":[{"code":"7720493","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1096.0,"discounted_cash":438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs As 14X16X9Mm Peek Cervical 4Deg Wedge","code_information":[{"code":"7720494","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":2446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs As 14X16X8Mm Peek Cervical 4Deg Wedge","code_information":[{"code":"7720495","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":2446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs As 14X16X7Mm Peek Cervical 4Deg Wedge","code_information":[{"code":"7720496","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":2446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 400Mm 130Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7720497","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7130.0,"discounted_cash":2852.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Line Etco2 Sampling Microstream Advance Short-Term Std 6.5Ft Adult Oral Nasal Filter Non-Intubat O2","code_information":[{"code":"7720498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bone Fixat Ncb 2X280Mm Kirschner Temp Smooth Single-Ended Trocar Tip","code_information":[{"code":"7720499","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Ncb 3.3Mm Prox Tibial Quick-Coupling Ss Ns","code_information":[{"code":"7720500","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":521.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Ncb 3.3X195Mm Prox Femur Quick-Coupling Ss Ns","code_information":[{"code":"7720501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Ncb 132Mm 3/5-Hole Lck Ti Non-Cont Bridge Lt Lat Prox Tibial F/Universal System Ns","code_information":[{"code":"7720502","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5654.0,"discounted_cash":2261.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X40Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X55Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X85Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X34Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Ncb 8Mm 3.5Mm Hex Head Lck Ti-6Al-4V Dist Femur F/Periprosthetic Frx Screw Ns","code_information":[{"code":"7720507","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 11Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720508","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6712.0,"discounted_cash":2684.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Prosthesis Penile Lg Sphincter Dbl Cuff Aus Placement Loaner","code_information":[{"code":"7720509","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":748.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cuff Penile Ams 800 4Cm Silicone Elastomer Saline-Filled Inflate Occlusive Pre-Connected Scrotal","code_information":[{"code":"7720510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":12615.0,"discounted_cash":5046.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Penile Ams 800 Silicone Elastomer W/Pump Control Inhibizone F/Stress Urinary Incontinence","code_information":[{"code":"7720511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":13163.0,"discounted_cash":5265.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Nasal Adult Supersoft Co2 7Ft O2 Tubing Univ Male Luer Conn Curve Non-Flare Prong Green Pvc","code_information":[{"code":"7720512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Avs As 14X12X6Mm Peek Cervical 4Deg Wedge","code_information":[{"code":"7720513","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6116.0,"discounted_cash":2446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 8 Univ Cement Primary Cocr F/Total Knee Arthropl Strl","code_information":[{"code":"7720514","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5623.0,"discounted_cash":2249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 8 Cement C/R Primary Tritanium Cocr Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7720515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8883.0,"discounted_cash":3553.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 8 9Mm Artic Surface C/R Fixed Bearing X3 F/Total Knee Arthropl","code_information":[{"code":"7720516","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6712.0,"discounted_cash":2684.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sling Ortho Envelope Xl 23.25X7In Arm Shoulder Strap D-Ring Hk-Loop Close Neck Pad Deep Pocket Dark","code_information":[{"code":"7720517","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stimulator Bone Implant W/Lead Mesh Cathode Detach Conn 20?A Generator Ebi Osteogen 20/M","code_information":[{"code":"7720518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":21284.0,"discounted_cash":8513.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Extern Fixat Ilizarov 1.5X300Mm Bayonet Point Cortic Ss Ns Reus","code_information":[{"code":"7720519","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Citadel 63Mm Lo-Pro 2Lvl Ti Ant Lumbosacral","code_information":[{"code":"7720520","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17344.0,"discounted_cash":6937.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immobilizer Ortho Xl Shoulder Contour Wrist/Humeral Cuff Chest Strap Hk-Loop Close Cotton Foam","code_information":[{"code":"7720521","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Hemodialysis Proguide Chronic Complete 14.5Frx28Cm 23Cm Tip To Cuff 2Lumen W/Gw Stylet","code_information":[{"code":"7720522","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle Ultamet Xl 40X56Mm Neutral Cocr Metal","code_information":[{"code":"7720523","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13920.0,"discounted_cash":5568.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 40Mm -2Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7720524","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7973.0,"discounted_cash":3189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Neurostim Elapass P2","code_information":[{"code":"7720525","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.0,"discounted_cash":1058.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/7-10 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720526","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6293.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs As 14X12X9Mm Peek Cervical 4Deg Wedge","code_information":[{"code":"7720527","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8243.0,"discounted_cash":3297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Citadel 26Mm 1Lvl Ti Ant Lumbosacral","code_information":[{"code":"7720528","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16289.0,"discounted_cash":6515.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Reflex Hybrid 4X10Mm Self-Drill Var Ang Pedicle Ti Blue Ant Cervical Sharp Tip","code_information":[{"code":"7720529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1066.0,"discounted_cash":426.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 11Mm Std 315Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Proceed 2X4   Pcdb1","code_information":[{"code":"7720532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":396.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular S-Rom 32Mm 10Deg Angle Constrain Gvf Poly-Dial Uhmwpe","code_information":[{"code":"7720533","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7800.0,"discounted_cash":3120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur S-Rom 32Mm Std +12Mm Neck 11/13 Taper Modul M-Specification Cocr Hip","code_information":[{"code":"7720534","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3026.0,"discounted_cash":1210.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular S-Rom 5Mm Lg 30Mm Headed Cancell Periph","code_information":[{"code":"7720535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":219.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular S-Rom 32Mm Lg 0Deg Angle Constrain Gvf Poly-Dial Uhmwpe","code_information":[{"code":"7720536","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7800.0,"discounted_cash":3120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X24Mm Cannul Lag Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":197.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X26Mm Cannul Lag Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720538","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":197.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 40Mm +5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip","code_information":[{"code":"7720539","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4509.0,"discounted_cash":1803.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 12Mm Std 360Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720540","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stimulator Bone Implant W/2-Lead 2-Straight Cathode Detach Conn 40?A Generator Ebi Osteogen 40/S","code_information":[{"code":"7720541","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":21284.0,"discounted_cash":8513.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Multiple Pin    71064005 Jet-X Bar Multiple Pin Clamp","code_information":[{"code":"7720542","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Cath Prelude Sheath 6Fr Short 4Cm Lg Bore Stopck Angle Side-Arm Tubing Pinch Clamp W/O Gw","code_information":[{"code":"7720543","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl 9X20X8Mm Peek Vertebral 4Deg Wedge","code_information":[{"code":"7720544","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9274.0,"discounted_cash":3709.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Retractor Endo Endopath Dextrus 7Cm Lg Fixed-Length","code_information":[{"code":"7720545","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":409.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 4Mm 35Mm Thread Ankle Foot Jet-X Ss Ns","code_information":[{"code":"7720547","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat 2/3 180Mm 7-Hole 0.66Mm Master Tab Ilizarov Taylor Spatial Frame Carbon Ns","code_information":[{"code":"7720548","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4311.0,"discounted_cash":1724.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Extern Fixat Ilizarov Rancho 4Mm Square Head Cntr Ankle Foot Ss Ns Reus","code_information":[{"code":"7720549","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 4X40Mm Thread Ankle Foot Hex-Fix Ti Ns","code_information":[{"code":"7720550","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":882.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Bone Marrow Aspirat Imbibe 8Ga 6In Bullet Tip Fenes Strl","code_information":[{"code":"7720551","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Substitute Foam 10Ml Resorb Compress Resist B-Tcp Bovine Collagen","code_information":[{"code":"7720552","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5310.0,"discounted_cash":2124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X24Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7720553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X26Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7720554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Variax 44Mm 5-Hole 1Mm Short Ti Polyaxial Column Specific Lat Dist Radial F/2.7Mm Screw","code_information":[{"code":"7720555","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":865.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acutrak 4/5 Sys 25Mm                        Am-0025","code_information":[{"code":"7720556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acutrak 4/5 Sys 30Mm                        Am-0030","code_information":[{"code":"7720557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 4/5 35Mm Cannul Headless Ti Hex Drive F/System Ns","code_information":[{"code":"7720558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acutrak 4/5 Sys 50Mm                        Am-0050","code_information":[{"code":"7720559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":599.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Protex 6X120Mm Curve Ti Thoracolum","code_information":[{"code":"7720560","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":455.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gauge Depth F/6.5-7.3Mm Screw","code_information":[{"code":"7720561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":40.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X48Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.0,"discounted_cash":296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tamp Kyphoplasty Kyphon Express Size 2 15Mm Inflate Bone","code_information":[{"code":"7720563","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4511.0,"discounted_cash":1804.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/7-10 14Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720564","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6293.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 11Mm Std 345Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720565","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Copeland Size 7 Resurfac Cocr Molybdenum Macrobond","code_information":[{"code":"7720566","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11631.0,"discounted_cash":4652.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Reflex 51Mm 8-Hole 2.1Mm Lo-Pro Lck Hybrid 3Lvl 1-Step Ti Curve Contour Ant Cervical","code_information":[{"code":"7720567","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4899.0,"discounted_cash":1959.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X56Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7720568","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3083.0,"discounted_cash":1233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Gore Propaten 8Mmx50Cm 40Cm Ringed Thin-Wall Strt Absorb Remov Ring Eptfe Heparin Coat","code_information":[{"code":"7720569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":5886.0,"discounted_cash":2354.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Gore Propaten 8Mmx80Cm 70Cm Ringed Thin-Wall Strt Remov Ring Eptfe Heparin Coat Aorta","code_information":[{"code":"7720570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8904.0,"discounted_cash":3561.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Matrix Bone Graft 100Ml Tibial Segment","code_information":[{"code":"7720571","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2953.0,"discounted_cash":1181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Endos 46Mm Head Std 165Mm Austin Moore Primary Fenes Strt Hip","code_information":[{"code":"7720572","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1084.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Univ Add 10Mm 1St Hole Imping Humeral F/Intramedullary Nail Platform","code_information":[{"code":"7720573","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Univ Add 5Mm 2Nd Hole Imping Humeral F/Intramedullary Nail Platform","code_information":[{"code":"7720574","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Chips Bone Graft 0.1-4Mm Allograft Void Filler 30Ml Frz-Dry Crush Cancell","code_information":[{"code":"7720575","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Accell Connexus Allograft 5Ml Dbm Human Poloxamer","code_information":[{"code":"7720576","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3116.0,"discounted_cash":1246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 10 16Mm Dist 46Mm Offst 160Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7720577","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14602.0,"discounted_cash":5840.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal X-Stop 12Mm Ti Strl","code_information":[{"code":"7720578","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16591.0,"discounted_cash":6636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Manual 1.7Mm Long Cannul F/2/2.4Mm Screw Hps","code_information":[{"code":"7720579","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":891.0,"discounted_cash":356.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 40Mm -5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip","code_information":[{"code":"7720580","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4509.0,"discounted_cash":1803.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shaft Bone Graft Matrigraft 8-15X150Mm Allograft Frozen Cort/Canc Fibula 5Yr Shelf Life","code_information":[{"code":"7720581","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2247.0,"discounted_cash":898.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Reflex 14Mm 4-Hole 2.1Mm Zero-Pro Lck 1Lvl 1-Step Ti Curve Contour Ant Cervical C2-T1","code_information":[{"code":"7720582","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5637.0,"discounted_cash":2254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kyphx Xpander Inflatable Bone Tamp                      K13A","code_information":[{"code":"7720583","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4148.0,"discounted_cash":1659.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Bone Graft Matrigraft >43Mm Allograft Frozen Femur 5Yr Shelf Life","code_information":[{"code":"7720584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4888.0,"discounted_cash":1955.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 8 Cement C/R Primary Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7720585","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9239.0,"discounted_cash":3695.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.2X12Mm Thread Cortic Ss Hex Head Clavicle Wrist Ankle Ns","code_information":[{"code":"7720586","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.2X14Mm Thread Cortic Ss Hex Head Clavicle Wrist Ankle Ns","code_information":[{"code":"7720587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone 7-Hole Parall Compress Ss F/Ulna Shortening Osteotomy Cut Ns","code_information":[{"code":"7720588","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2626.0,"discounted_cash":1050.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.2X18Mm Lag Partial Thread Cortic Ss Ulnar Radial Ns","code_information":[{"code":"7720589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 1.6X65Mm Kirschner Temp","code_information":[{"code":"7720590","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 1.6X100Mm Kirschner Temp","code_information":[{"code":"7720591","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill 2.33Ol","code_information":[{"code":"7720592","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Saw Oscillat M-Type 9Mm","code_information":[{"code":"7720593","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dvr 24.4X51.3Mm 5-Hole Short Timax Anatomic Rt Dist Volar Radial Fast Guide Kirschner Ns","code_information":[{"code":"7720594","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3009.0,"discounted_cash":1203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"K-Wire                 Kw062Ss","code_information":[{"code":"7720595","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":40.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Bit               Fdb2.0","code_information":[{"code":"7720596","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2.5X20Mm Screw Lck Perm Partial Thread Cocr Dist Radial Volar Blue Ns","code_information":[{"code":"7720597","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Mozaik 100X25X6Mm Void Filler 15Ml Resorb Scaffold Compress Resist B-Tcp Type I","code_information":[{"code":"7720598","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5660.0,"discounted_cash":2264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Bone Marrow Aspirat Aspirex","code_information":[{"code":"7720599","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Reflex Hybrid 4.5X12Mm Self-Tap Var Ang Pedicle Ti Green Ant Cervical Cut Flute Less","code_information":[{"code":"7720600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Radius 5.5X40Mm Non-Hexagonal Ti Pedicle Thoracolum Ns","code_information":[{"code":"7720601","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Dbm Accell Isotis                    02-3000-010","code_information":[{"code":"7720602","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nut Ortho Trigen Stable-Lok 5Mm Int Cap W/Washer","code_information":[{"code":"7720603","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":407.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X80Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7720604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.0,"discounted_cash":296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Peek Oblique","code_information":[{"code":"7720605","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15084.0,"discounted_cash":6033.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Neoform 4X20Cm Mesh Uniform Press Teflon Surface Protect","code_information":[{"code":"7720606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":8791.0,"discounted_cash":3516.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Substitute Foam 5Ml Resorb Compress Resist B-Tcp Bovine Collagen","code_information":[{"code":"7720607","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1065.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 94Mm 5-Hole 11.7X40Mm Blade 95Deg Angle Compress Lck Ss Limit-Cont F/4.5Mm Screw Ns","code_information":[{"code":"7720608","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3075.0,"discounted_cash":1230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Ft160","code_information":[{"code":"7720611","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Xpode Cup 18Mm 9-Hole Peek-Optima Fusion Hand F/Arthrodesis Surg System Adult Ns","code_information":[{"code":"7720612","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3588.0,"discounted_cash":1435.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X10Mm","code_information":[{"code":"7720613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 16/20Mm P/D 8.5Mm Flared Woven Iliac Ext Cuff","code_information":[{"code":"7720614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13200.0,"discounted_cash":5280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 16Mm P/D 5.5Cm Strt Woven Iliac Ext Cuff","code_information":[{"code":"7720615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9052.0,"discounted_cash":3620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Nexgen 13X100Mm 145Mm Strt Pre-Coated Offst Flute Sharp Solid Tivanium Tibial Knee","code_information":[{"code":"7720616","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":1392.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 9Mm Std 285Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7720617","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Sm 10X22X15Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720618","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14707.0,"discounted_cash":5882.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Optisense Implant 46Cm Atrial","code_information":[{"code":"7720619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3588.0,"discounted_cash":1435.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Bipol 52Cm Ventric Steroid Elut Is-1 Conn Tin Electrode","code_information":[{"code":"7720620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3362.0,"discounted_cash":1344.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Hemodialysis Hemoglide Chronic 14.5Fr Lg Lumen 24Cm 17Cm 2Lumen Bodysoft Plus Pur Pced","code_information":[{"code":"7720621","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Ba Substitute Foam 2.5Ml Bioactive Resorb Compress Resist B-Tcp Bovine","code_information":[{"code":"7720623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1529.0,"discounted_cash":611.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 15.5Cm 6Cm Hp 800Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7720624","type":"CDM"},{"code":"270","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3491.0,"discounted_cash":1396.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stapler Skin Ss Nickel Precise Vista Box Style Angle Head Retract Anvil Proximate","code_information":[{"code":"7720625","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 40X60Mm +4 Neutral 10Deg Angle Marathon","code_information":[{"code":"7720626","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9455.0,"discounted_cash":3782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Gore Propaten 6Mmx40Cm Std Wall Strt Long Hndl Ergo Grip Eptfe Heparin Coat Aortic Lf","code_information":[{"code":"7720627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3662.0,"discounted_cash":1464.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 3.2Mm Calib","code_information":[{"code":"7720628","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Polyax 233.5Mm 9-Hole Lck Timax Rt Dist Femur Ns","code_information":[{"code":"7720629","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5515.0,"discounted_cash":2206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X30Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7720630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 40Mm 10Mm Asymm Pe Strl","code_information":[{"code":"7720631","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2695.0,"discounted_cash":1078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 110Mm 7-Hole Pre-Contoured Compress Lck Ss Lt Dist Medial Humeral F/3.5Mm Screw Sm","code_information":[{"code":"7720632","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4095.0,"discounted_cash":1638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 90Mm 5-Hole Pre-Contoured Compress Lck Ss Lt Post/Lat Dist Humeral F/3.5Mm Screw Sm","code_information":[{"code":"7720633","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4196.0,"discounted_cash":1678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Inlay 8Fr X 22Cm  787822 Ureteral","code_information":[{"code":"7720634","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":274.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Neoform 6X20Cm Mesh Uniform Press Teflon Surface Protect","code_information":[{"code":"7720635","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8791.0,"discounted_cash":3516.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast 14.2-14.8Cm 4.2-4.9Cm Moderate-Profile 475-525Ml Saline-Filled Smooth Ant Diaphragm","code_information":[{"code":"7720636","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2079.0,"discounted_cash":831.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X10Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X12Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X14Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X26Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X34Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X36Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720642","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X30Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720643","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X32Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7720644","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Sm 10X22X12Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720645","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Sm 10X22X13Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720646","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Revere 6/7.5X35Mm Lck Polyaxial Dual Outer Diameter Cort/Canc Pedicle Ti Top Load","code_information":[{"code":"7720647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3588.0,"discounted_cash":1435.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 3-Hole Bearing 6-Peg Rt Volar","code_information":[{"code":"7720648","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3757.0,"discounted_cash":1502.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 20Mm Perm Non-Threaded Ss Radial Volar","code_information":[{"code":"7720649","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.2X12Mm Lo-Pro Cortic Ss Ns","code_information":[{"code":"7720650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 22Mm Perm Non-Threaded Ss Radial Volar","code_information":[{"code":"7720651","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 18Mm Perm Non-Threaded Ss Radial Volar","code_information":[{"code":"7720652","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal X-Stop 14Mm Ti Strl","code_information":[{"code":"7720653","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17441.0,"discounted_cash":6976.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.2X16Mm Thread Cortic Ss Hex Head Clavicle Wrist Ankle Ns","code_information":[{"code":"7720654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.2X20Mm Thread Cortic Ss Hex Head Clavicle Wrist Ankle Ns","code_information":[{"code":"7720655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.2X22Mm Thread Cortic Ss Hex Head Clavicle Wrist Ankle Ns","code_information":[{"code":"7720656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Sidewinder 6-Hole Wide Lt","code_information":[{"code":"7720657","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2626.0,"discounted_cash":1050.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 2.3X120Mm","code_information":[{"code":"7720658","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X26X15Mm Self-Distract Peek Ti Thoracolum Oblique","code_information":[{"code":"7720659","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X48Mm Cannul Compress Lck Partial Thread Ss Hex Socket Hemispherical Head Radial","code_information":[{"code":"7720660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 2.7X16Mm Non-Locking Fusion Ss Hex Head 1St Mtp Ankle Foot F/Lisfranc Frx Ns","code_information":[{"code":"7720661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 2.7X18Mm Non-Locking Fusion Ss Hex Head 1St Mtp Ankle Foot F/Lisfranc Frx Ns","code_information":[{"code":"7720662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 2.7X12Mm Non-Locking Fusion Ss Hex Head 1St Mtp Ankle Foot F/Lisfranc Frx Ns","code_information":[{"code":"7720663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Mantis 6X100Mm Curve Hex Ti Thoracolum Malleab Min Radius Ns Laser Etch","code_information":[{"code":"7720664","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2242.0,"discounted_cash":896.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Peak Fx 3.2Mm","code_information":[{"code":"7720665","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Peak Fx 3.8Mm Calib","code_information":[{"code":"7720666","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hip Compo Peak Fx 100X125Mm Lag Assembly Ns","code_information":[{"code":"7720667","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peak Fx 2-Hole Compress Ti Std Barrel Ns","code_information":[{"code":"7720668","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":530.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X42Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7720669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X44Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7720670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pump Penile Ams 700 12Mmx18Cm Saline-Filled Control Expans Inflate Pre-Connected Penoscrotal Cylindr","code_information":[{"code":"7720671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":23752.0,"discounted_cash":9500.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 73Mm 4-Hole Buttress Ss Lt Lat Dist Fibula F/2.7/3.5Mm Cort/Canc Screw Strl","code_information":[{"code":"7720674","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1503.0,"discounted_cash":601.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X18Mm Non-Cannulated Lck Self-Tap Fixed Angle Cortic Ss Periarticular Elbow W/2.7Mm","code_information":[{"code":"7720675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X12Mm Non-Cannulated Lck Self-Tap Fixed Angle Cortic Ss Periarticular Elbow W/2.7Mm","code_information":[{"code":"7720676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Forte 4X12Mm Partial Thread Cancell Ss Hex Head Ns","code_information":[{"code":"7720677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 11.3Cm 3.4Cm Mod Plus-Profile 250Ml Silicone Gel Smooth Ant","code_information":[{"code":"7720678","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.0,"discounted_cash":1359.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 11.7Cm 3.5Cm Mod Plus-Profile 275Ml Silicone Gel Smooth Ant","code_information":[{"code":"7720679","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.0,"discounted_cash":1359.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Ncb 1.6Mm 190Mm Thread Ss Ns","code_information":[{"code":"7720680","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Ncb 3.3X195Mm Prox Tibial Quick-Coupling Ss Ns","code_information":[{"code":"7720681","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X50Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Ncb 4.3X195Mm Im Femur Quick-Coupling Ss Ns","code_information":[{"code":"7720683","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X36Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X46Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X70Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X44Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7720687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 5X55Mm Non-Cannulated Non-Locking 32Mm Partial Thread Polyaxial Self-Tap Cancell","code_information":[{"code":"7720688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cap Endoscope Sealing Endopath Dextrus Assembly W/Marking Pen Ruler Forearm Wrap","code_information":[{"code":"7720689","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2036.0,"discounted_cash":814.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sponge Ilizarov         102140","code_information":[{"code":"7720690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 54Mm 8-Hole Lck 3Lvl Ti Ant Cervical","code_information":[{"code":"7720691","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4718.0,"discounted_cash":1887.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Providence 4.2X14Mm Self-Drill Var Ang Ti Ant Cervical Ns","code_information":[{"code":"7720692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Versanail 7Mm Univ 240Mm Cannul Lck Humeral Ti Alloy Strl","code_information":[{"code":"7720693","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5904.0,"discounted_cash":2361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Univ Flush 1St Hole Imping Humeral F/Intramedullary Nail Platform","code_information":[{"code":"7720694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versanail 3.5X24Mm Non-Locking Full Thread Solid Cortic Hex Prox Humeral F/8Mm Nail 2.9Mm","code_information":[{"code":"7720695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11X180Mm 125Deg Angle Lck Dist Femur Trochan Ti Strl","code_information":[{"code":"7720696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4899.0,"discounted_cash":1959.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 7 Cement Primary Bead Cocr Peri-Apatite Knee","code_information":[{"code":"7720697","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7658.0,"discounted_cash":3063.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 38Mm 11Mm Primary Asymm Tritanium Backed Metal Pe Super Inferior","code_information":[{"code":"7720698","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4354.0,"discounted_cash":1741.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 19Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720699","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 6 Cement Post Stabil Tritanium Cocr Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7720700","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7878.0,"discounted_cash":3151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 16Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7720701","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5489.0,"discounted_cash":2195.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Binder Abdomin 4-Panel Prem Lg Xl 12In Unisex 46-62In Contact Close Elastic Lf Plain Box","code_information":[{"code":"7720702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Triathlon Size 5 16Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720703","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/3-4 66Mm/42Mm 10Mm Net Shape Lt Rt Condylar Knee Artic Surface","code_information":[{"code":"7720704","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5950.0,"discounted_cash":2380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size D 74/46Mm Cement Constrain Revis Zimaloy Non-Porous Lt Condylar","code_information":[{"code":"7720705","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18383.0,"discounted_cash":7353.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Nexgen 14X100Mm 145Mm Strt Pre-Coated Offst Flute Sharp Solid Tivanium Tibial Knee","code_information":[{"code":"7720706","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3482.0,"discounted_cash":1392.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hex Wrench             5987-71","code_information":[{"code":"7720707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Laryngectomy Singer Size 10 12X15X27Mm Non-Adher Unique Flange W/Neck Strap Silicone Lf Strl","code_information":[{"code":"7720708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 14Mm P/D Med 11.5Mm Strt Woven Iliac Ext Cuff","code_information":[{"code":"7720709","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11502.0,"discounted_cash":4600.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 24/14Mm Aortic/Iliac Short 13.5Cm Bifurc Woven","code_information":[{"code":"7720710","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29312.0,"discounted_cash":11724.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat 2/3 205Mm 7-Hole 0.66Mm Master Tab Ilizarov Taylor Spatial Frame Alum Ns","code_information":[{"code":"7720711","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4311.0,"discounted_cash":1724.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Size B Unicompart High Flexion Zimaloy Rt Medial Lt Lat","code_information":[{"code":"7720712","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10610.0,"discounted_cash":4244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 80Mm 5-Hole Pre-Contoured Compress Lck Ss Lt Ant/Lat Dist Tibial F/3.5Mm Screw Ns","code_information":[{"code":"7720713","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 22Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720715","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Sm 10X22X11Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720716","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 5.5Mm Revere F/Pedicle Screw Lf","code_information":[{"code":"7720717","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":529.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Marker Breast Biopsy Mammomark 15Ga 13Cm Hourglass","code_information":[{"code":"7720718","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Provox 2 Voice Prothesis 4.5Mm                           721","code_information":[{"code":"7720719","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Provox 2 Voice Prothesis 6Mm                           7217","code_information":[{"code":"7720720","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Provox 2 Voice Prothesis 8Mm                           7218","code_information":[{"code":"7720721","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 320Mm 130Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7720722","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7130.0,"discounted_cash":2852.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 14Mm 4-Hole Lck 1Lvl Ti Ant Cervical","code_information":[{"code":"7720723","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3965.0,"discounted_cash":1586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Providence 4.2X12Mm Self-Drill Var Ang Ti Ant Cervical Ns","code_information":[{"code":"7720724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Colonial Lg 14X8X12Mm Self-Distract Peek Ant Cervical 7Deg Lordot Ns","code_information":[{"code":"7720725","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4908.0,"discounted_cash":1963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 5X100Mm 135Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7720726","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":440.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Carnoy Solution 50Cc   7298814 Nyes Pharm Fixative Solution","code_information":[{"code":"7720727","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/3-4 17Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720728","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6293.0,"discounted_cash":2517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Nexgen Legacy Lck Tivanium Uhmwpe Tibial Flute F/Stem Ext","code_information":[{"code":"7720729","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":164.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 6X40Mm 75Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720730","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 7X40Mm 75Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720731","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Conquest Post-Dilatation 8X40Mm 75Cm Otw Non-Compli Coaxial F/Pta Ultra","code_information":[{"code":"7720732","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":387.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Continental Med 35X15X24Mm Peek Ant Lumb 8Deg Lordot","code_information":[{"code":"7720733","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16215.0,"discounted_cash":6486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Citadel 66Mm Lo-Pro 2Lvl Ti Ant Lumbosacral","code_information":[{"code":"7720734","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20308.0,"discounted_cash":8123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Continental Sm 29X15X22Mm Peek Ant Lumb 8Deg Lordot","code_information":[{"code":"7720735","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16215.0,"discounted_cash":6486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Polyax 99.6Mm 2-Hole Pre-Contoured Lck Timax Lt Prox Tibial Ns","code_information":[{"code":"7720736","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5515.0,"discounted_cash":2206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X70Mm Non-Locking Partial Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7720737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X36Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.0,"discounted_cash":296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size D 64/57.5Mm Cement Post Stabil Zimaloy Non-Porous Lt Lat Strl","code_information":[{"code":"7720739","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12027.0,"discounted_cash":4810.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size C 60/53.5Mm Cement Post Stabil Zimaloy Non-Porous Lt Lat Strl","code_information":[{"code":"7720740","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12027.0,"discounted_cash":4810.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/1-2 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7720741","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6702.0,"discounted_cash":2680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X90Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720742","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Patch Vasc Hemacarotid 8X75Mm 0.41Mm Ultrathin-Wall Revers Lock Knit Extern Velour Type 1 Bovine","code_information":[{"code":"7720743","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guiderod Ortho Trigen 2Mm 600Mm Grad Ball Tip Humeral Strl","code_information":[{"code":"7720744","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 5X34Mm Lck Self-Tap Cancell Ti Hex Head Green Prox Humeral","code_information":[{"code":"7720745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":314.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Trigen 3.2Mm 248Mm Thread Humeral","code_information":[{"code":"7720746","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":247.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Trigen 3.2Mm Long Humeral 2-Flute Grad S N Brad Pt","code_information":[{"code":"7720747","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":355.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 9/7.5Mm Long 260Mm Bend Cannul Antegrade/Retrograde Multi-Planar Humeral Ti Alloy","code_information":[{"code":"7720748","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5963.0,"discounted_cash":2385.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Neoform 4Cmx16Mm Acell Dermis","code_information":[{"code":"7720749","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6923.0,"discounted_cash":2769.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 15.8Cm 4.9Cm Mod Plus-Profile 700Ml Silicone Gel Smooth Ant","code_information":[{"code":"7720750","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.0,"discounted_cash":1359.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 16.5Cm 5.1Cm Mod Plus-Profile 800Ml Silicone Gel Smooth Ant","code_information":[{"code":"7720751","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.0,"discounted_cash":1359.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 48Mm 8-Hole Lck 3Lvl Ti Ant Cervical","code_information":[{"code":"7720752","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4718.0,"discounted_cash":1887.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Spinal Fixat Providence Screw Temp Ant Cervical Strl","code_information":[{"code":"7720753","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 17.4Cm 3.9Cm Moderate-Profile 700Ml Silicone Gel Smooth Ant","code_information":[{"code":"7720755","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3304.0,"discounted_cash":1321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 18Cm 4.1Cm Mod Hp 800Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7720756","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3304.0,"discounted_cash":1321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Matrix Bone Graft 3.5Mg Frz-Dry Human Protein","code_information":[{"code":"7720757","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18851.0,"discounted_cash":7540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Delivery 2.5Mmx180Cm Sgl Sheathed F/Endo Capsule 10.5-11.5Mm 23.5-26.5Mm Stomach Duodenum","code_information":[{"code":"7720758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":191.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Spinal Providence 51Mm 8-Hole Lck 3Lvl Ti Ant Cervical","code_information":[{"code":"7720759","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4718.0,"discounted_cash":1887.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 14.8Cm 5.8Cm Hp 700Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7720760","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3491.0,"discounted_cash":1396.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Shaver Rhinotec Cuda Sterling Arthro 3.5Mmx7.6Cm Ent Strt Dual Serr Micro Hub Magenta F/E9005","code_information":[{"code":"7720761","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4X50Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cancell Ti Bullet Shape Tip","code_information":[{"code":"7720762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X32Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7720763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Cslp 16X20Mm 12Mm 2-Hole 2Mm Lck 1Lvl Ti Narrow Ant Cervical Light Blue Ns","code_information":[{"code":"7720764","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3386.0,"discounted_cash":1354.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Cslp 4X14Mm Lck Self-Drill Expans Head Cortic Ti Cervical Ns","code_information":[{"code":"7720765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":460.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Cslp 4X12Mm Lck Self-Drill Expans Head Cortic Ti Cervical Ns","code_information":[{"code":"7720766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":460.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Cslp 4X16Mm Lck Self-Drill Expans Head Cortic Ti Cervical Ns","code_information":[{"code":"7720767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":460.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat Lg Multi To Pin Dynamization 6 Position Dist Radial Carbon Fiber F/Fixator System","code_information":[{"code":"7720768","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2944.0,"discounted_cash":1177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Extern Fixat Lg Multi-Pin Clamp Dynamization 4-Position Attachment/Mlt Post Dist Radial Ss","code_information":[{"code":"7720769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1651.0,"discounted_cash":660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Clamp Extern Fixat Lg 5 To Position Combinational Dist Radial Carbon Fiber F/Fixator System Mri-Safe","code_information":[{"code":"7720770","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2587.0,"discounted_cash":1034.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 11X300Mm Conn Dist Radial Carbon Fiber F/Large Fixator System Ns","code_information":[{"code":"7720771","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":377.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cap Protect Ns F/5Mm Fixat Pin Blue","code_information":[{"code":"7720772","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Extern Fixat Schanz 5Mm Lg 200Mm 80Mm Thread Self-Drill Blunt Trocar Point Chondral Hip Femur","code_information":[{"code":"7720773","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Pin Extern Fixat Steinmann 6Mm Lg 225Mm Transfixation Asif Ss F/Schanz Screw Ns","code_information":[{"code":"7720774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Spinal Providence 30Mm 6-Hole Lck 2Lvl Ti Ant Cervical","code_information":[{"code":"7720775","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4151.0,"discounted_cash":1660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Distractor Secure-C 12Mm Cervical Spinal Lf Ns F/Artificial Disc","code_information":[{"code":"7720776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":266.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone 5-Hole 4-Peg Ss Lt Volar Wrist Bearing","code_information":[{"code":"7720777","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4009.0,"discounted_cash":1603.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size D 64/57.5Mm Cement Post Stabil Zimaloy Non-Porous Rt Lat Strl","code_information":[{"code":"7720778","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12027.0,"discounted_cash":4810.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 6 Cement Primary Bead Cocr Knee","code_information":[{"code":"7720779","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6231.0,"discounted_cash":2492.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 35Mm 10Mm Asymm X3 Metal W/Peri-Apatite Strl","code_information":[{"code":"7720780","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2858.0,"discounted_cash":1143.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Dnp 3.3Mmx4In Volar Qck-Conn Strl Disp F/Anatomic Plate System","code_information":[{"code":"7720781","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Ba Substitute Foam 1.2Ml Bioactive Resorb Compress Resist B-Tcp Bovine","code_information":[{"code":"7720782","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":315.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 2 Cementls C/R Bead Lt","code_information":[{"code":"7720783","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10137.0,"discounted_cash":4054.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 3 11Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720784","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X40Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Hps 0.035X4In Kirschner Temp Dbl Trocar Point Ss F/2/2.4Mm Screw","code_information":[{"code":"7720786","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1734","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2X24Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X34Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X36Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 13Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720790","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X24Mm Cannul Long Thread Self-Drilling/Tapping Ss Cruciform Recess Head Wrist Hand Foot","code_information":[{"code":"7720791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":307.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 112Mm 4-Hole Pre-Contoured Compress Lck Ss Lt Olecranon F/3.5Mm Screw Ns","code_information":[{"code":"7720792","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3392.0,"discounted_cash":1356.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size C 60/53.5Mm Cement Post Stabil Zimaloy Non-Porous Rt Lat Strl","code_information":[{"code":"7720793","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12027.0,"discounted_cash":4810.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Cementls C/R Bead Tritanium Cocr Peri-Apatite Lt F/Total Knee","code_information":[{"code":"7720794","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12449.0,"discounted_cash":4979.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X20Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X34Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 16Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720797","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Tru-Cut Standalone 18Ga 3In 20Mm Sample Notch Bevel Scalpel-Sharp Thin-Wall Kidney","code_information":[{"code":"7720798","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Continental Med 35X13X24Mm Peek Ant Lumb 15Deg Lordot","code_information":[{"code":"7720799","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16215.0,"discounted_cash":6486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size F 72/65.5Mm Cement Post Stabil Zimaloy Non-Porous Rt Lat Strl","code_information":[{"code":"7720800","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12027.0,"discounted_cash":4810.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Retain R 20X12Mm Parall","code_information":[{"code":"7720801","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":21982.0,"discounted_cash":8792.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Retain R 20X14Mm Parall","code_information":[{"code":"7720802","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":21982.0,"discounted_cash":8792.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Microintroducer Vasc Microez Safety 6Frx7Cm Lck Collar Ergo Hndl W/35Cm Ss Gw A Bevel Ndl Blue","code_information":[{"code":"7720803","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Microintroducer Vasc Microez Safety 5Fr Long 7Cm Lck Collar Ergo Hndl W/35Cm Ss Gw A Bevel Ndl","code_information":[{"code":"7720804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reamer Surg Sharps Wire","code_information":[{"code":"7720805","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":303.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Suture Capturing 12Mm Capio Cl Lf Open Access 25Cm Pelvic Strt Direct Vision","code_information":[{"code":"7720806","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1256.0,"discounted_cash":502.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Eth:Bond        833-113","code_information":[{"code":"7720807","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":71.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Expert 2Mm Univ 440Mm Antegrad Elastic Tibial Ti Solid Green F/Diaphyseal Frx Fixat Ns","code_information":[{"code":"7720808","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":373.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Expert 1.5Mm Univ 300Mm Antegrad Elastic Tibial Ti Solid Purple F/Diaphyseal Frx Fixat Ns","code_information":[{"code":"7720809","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Expert 5Mm Ext Ti Pink F/3-4Mm Elastic Im Nail Ns","code_information":[{"code":"7720810","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X100Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720811","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 5Mm 50Deg Angle 360Deg Total Rotat Intermed Rod-Pin Cartridge Capture Jet-X","code_information":[{"code":"7720812","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":750.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size E 32Mm 50-52Mm 7.9Mm 10Deg Angle Primary X3 W/Hemispherical Shell","code_information":[{"code":"7720813","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3889.0,"discounted_cash":1555.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 32Mm +5Mm Neck C-Tapered Primary Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7720814","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2025.0,"discounted_cash":810.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Distractor Secure-C 14Mm Cervical Spinal Lf Ns F/Artificial Disc","code_information":[{"code":"7720815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":266.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Colonial Lg 14X7X12Mm Self-Distract Peek Ant Cervical 7Deg Lordot Ns","code_information":[{"code":"7720816","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4908.0,"discounted_cash":1963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Colonial Lg 14X6X12Mm Self-Distract Peek Ant Cervical 7Deg Lordot Ns","code_information":[{"code":"7720817","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4908.0,"discounted_cash":1963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 66Mm 10-Hole Lck 4-Level Ti Ant Cervical","code_information":[{"code":"7720818","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5095.0,"discounted_cash":2038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Providence 4.2X14Mm Self-Drill Fixed Angle Ti Ant Cervical Ns","code_information":[{"code":"7720819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Providence 14Mm Spinal Qck-Conn Strl Reus","code_information":[{"code":"7720820","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Extern Fixat 400Mm Thread Lg Bone Tibial Ilizarov Ss F/Foot Ankle System Ns","code_information":[{"code":"7720821","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 45Mm 8-Hole Lck 3Lvl Ti Ant Cervical","code_information":[{"code":"7720822","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4718.0,"discounted_cash":1887.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Providence 4.2X14Mm Self-Tap Fixed Angle Ti Ant Cervical Ns","code_information":[{"code":"7720823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Providence 12Mm Spinal Qck-Conn Strl Reus","code_information":[{"code":"7720824","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X44Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X35Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7720826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 8X85Mm Cannul Lck Full Thread Polyaxial Self-Tap Fixed Angle Cancell Ti Bullet","code_information":[{"code":"7720827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Inflat Bln Cath Se High Press 7X24Mm Sinus F/Eustachian Tube Disp Ga Vac","code_information":[{"code":"7720828","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Secur-Fit Size 9 150Mm Cementls Collar Ti Arc Hap Plasma Spray 132Deg Angle Hip","code_information":[{"code":"7720829","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23576.0,"discounted_cash":9430.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Catheter Picc Turbo-Ject 5Frx60Cm 2Lumen Power Inject W/Peel-Away 0.018In 65Cm Nt Gw 21Ga 7Cm","code_information":[{"code":"7720830","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Cope Workhorse 0.018Inx125Cm 7X7.25Cm Taper Angle Tip Soft Flex Spring Coiled Nitinol","code_information":[{"code":"7720831","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Monodek Capio #0 48In 1/2 Circ Dbl-Arm Tapercut 833-137 Monofil Pdo 26Mm Absorb","code_information":[{"code":"7720832","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 3-Hole 4-Peg Ss Fixed Angle Lt Volar","code_information":[{"code":"7720833","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":944.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 1.75X18Mm Screw Perm Thread Ss Radial Volar","code_information":[{"code":"7720834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X62Mm Neutral 0Deg Angle Marathon","code_information":[{"code":"7720835","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4677.0,"discounted_cash":1870.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X48Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 6.5Mm Revere F/Pedicle Screw Lf","code_information":[{"code":"7720837","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1324.0,"discounted_cash":529.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X95Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7720838","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Variax 2.7X22Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7720839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 36Mm 6-Hole Lck 2Lvl Ti Ant Cervical","code_information":[{"code":"7720840","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":1736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Colonial Lg 14X9X12Mm Self-Distract Peek Ant Cervical 7Deg Lordot Ns","code_information":[{"code":"7720841","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4908.0,"discounted_cash":1963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Colonial Lg 14X10X12Mm Self-Distract Peek Tps Ant Cervical 7Deg Lordot Ns","code_information":[{"code":"7720842","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4908.0,"discounted_cash":1963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pump Ms 700Lgx 21X12  72404253 Preconnect Iz","code_information":[{"code":"7720843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":24996.0,"discounted_cash":9998.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Triathlon 15X100Mm Cementls Revis Total Stabil Press-Fit Flute Ti Knee W/Trial Cut","code_information":[{"code":"7720845","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2924.0,"discounted_cash":1169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur Triathlon 2Mm Offst Revis Total Stabil Hip F/Knee System Strl","code_information":[{"code":"7720846","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Bone Hydroset 5Ml","code_information":[{"code":"7720847","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 30Mm Std Narrow Contour Lck Lo-Pro Ti Rt Dist Volar Radial Green Ns","code_information":[{"code":"7720848","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3382.0,"discounted_cash":1352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acu-Loc 2Mmx5In Dist Radial Qr Ss Strl","code_information":[{"code":"7720849","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X12Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7720850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X10Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7720851","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Acu-Loc 2 2.3X20Mm Lck Perm Smooth Ti Dist Radial Volar Cortic Ns F/Plating System","code_information":[{"code":"7720852","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Peg Bone Fixat Acu-Loc 2 2.3X22Mm Lck Perm Smooth Ti Dist Radial Volar Cortic Ns F/Plating System","code_information":[{"code":"7720853","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.3X14Mm Lck Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist Hand","code_information":[{"code":"7720854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 2.3X16Mm Lck Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist Hand","code_information":[{"code":"7720855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.5,"discounted_cash":187.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 2.3X20Mm Lck Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist Hand","code_information":[{"code":"7720856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Trident Size E 36Mm 50-52Mm 10Deg Angle Primary Crossfire Strl","code_information":[{"code":"7720857","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":1475.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 35Mm 10Mm Asymm Pe Strl","code_information":[{"code":"7720858","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2111.0,"discounted_cash":844.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 13Mm Artic Surface C/R Convent Pe","code_information":[{"code":"7720859","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3903.0,"discounted_cash":1561.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Expert 2.5Mm Univ 440Mm Antegrad Elastic Tibial Ti Solid Pink F/Diaphyseal Frx Fixat Ns","code_information":[{"code":"7720860","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 3 11Mm Artic Surface C/R Convent Pe","code_information":[{"code":"7720861","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3903.0,"discounted_cash":1561.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 5.5Mm Array Qck-Conn Shaft Cannul F/Screw","code_information":[{"code":"7720862","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2223.0,"discounted_cash":889.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peek Sustain O 10Mm    304.090","code_information":[{"code":"7720863","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X40Mm Non-Locking Full Thread Self-Tap Solid Cortic Ti F/Small Frag Plate","code_information":[{"code":"7720864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X42Mm Non-Locking Full Thread Self-Tap Solid Cortic Ti F/Small Frag Plate","code_information":[{"code":"7720865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":65.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 8X90Mm Cannul Lck Full Thread Polyaxial Self-Tap Fixed Angle Cancell Ti Bullet","code_information":[{"code":"7720866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":876.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Cement Total Stabil Revis Tritanium Cocr Rt Strl","code_information":[{"code":"7720867","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14818.0,"discounted_cash":5927.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur Triathlon 4Mm Offst Revis Total Stabil Dist Hip F/Knee System Strl","code_information":[{"code":"7720868","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Triathlon Size 5 10Mm Total Stabil Cocr Rt Dist Knee Strl","code_information":[{"code":"7720869","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2946.0,"discounted_cash":1178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 Std 19Mm Artic Surface Total Stabil Plus Flexion X3 Strl","code_information":[{"code":"7720870","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5803.0,"discounted_cash":2321.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Triathlon Size 5 5Mm Total Stabil Cocr Post Knee Strl","code_information":[{"code":"7720871","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2808.0,"discounted_cash":1123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Triathlon Size 5 5Mm Total Stabil Cocr Rt Dist Knee Strl","code_information":[{"code":"7720872","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2808.0,"discounted_cash":1123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Balloon 5X16 Bc0516Rs Sinus","code_information":[{"code":"7720873","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1727","type":"HCPCS"}],"standard_charges":[{"gross_charge":2632.0,"discounted_cash":1052.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 32Mm 6-Hole Lck 2Lvl Ti Ant Cervical","code_information":[{"code":"7720874","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":1736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Retain R 16X12Mm Parall","code_information":[{"code":"7720875","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":21982.0,"discounted_cash":8792.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 9Mm Artic Surface C/R Convent Pe","code_information":[{"code":"7720876","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4875.0,"discounted_cash":1950.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 42Mm 8-Hole Lck 3Lvl Ti Ant Cervical","code_information":[{"code":"7720877","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4718.0,"discounted_cash":1887.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Providence 4.2X12Mm Self-Tap Fixed Angle Ti Ant Cervical Ns","code_information":[{"code":"7720878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pacemaker Cardiac Adapta Dr Addrl101Id Implant Unipol Bipol Lg 52.3X45.4X7.5Mm 13.1Cm3 2-Chamber","code_information":[{"code":"7720879","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22621.0,"discounted_cash":9048.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pump Penile Ams 700 Lgx 12Mmx15Cm Saline-Filled Inflate Pre-Connected Penoscrotal Cylindr","code_information":[{"code":"7720880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":24996.0,"discounted_cash":9998.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Triathlon Size 8 13Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7720881","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 50Mm Contour Lck Lo-Pro Ti Std Lt Dist Volar Radial Blue Ns","code_information":[{"code":"7720882","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3382.0,"discounted_cash":1352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Acu-Loc 2 0.054In 6In Sgl Trocar Tip Ss F/K-Wire Position Ns Disp","code_information":[{"code":"7720883","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Sustain Sm 10X22X10Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720884","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Sm 8X22X10Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720885","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X14Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7720886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X14Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7720887","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X16Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7720888","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.3X22Mm Lck Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist Hand","code_information":[{"code":"7720889","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Polarus 3.5X12Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7720890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Vitoss Ba 25X100X4Mm Substitute 10Ml Bioactive Resorb Compress Resist B-Tcp Bovine","code_information":[{"code":"7720891","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7489.0,"discounted_cash":2995.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Vitoss Ba 25X50X4Mm Substitute 5Ml Bioactive Resorb Compress Resist B-Tcp Bovine","code_information":[{"code":"7720892","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4791.0,"discounted_cash":1916.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X16Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7720893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Acu-Loc 2 2.3X24Mm Lck Perm Smooth Ti Dist Radial Volar Cortic Ns F/Plating System","code_information":[{"code":"7720894","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.3X18Mm Lck Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist Hand","code_information":[{"code":"7720895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Omnifit Hfx Size 9 41Mm Offst 150Mm Cement Primary Reconstruct Cocr 132Deg Angle 35Mm","code_information":[{"code":"7720896","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9211.0,"discounted_cash":3684.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 29Mm 9Mm Asymm Pe Strl","code_information":[{"code":"7720897","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2695.0,"discounted_cash":1078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 3 11Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7720898","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 11Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7720899","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Retain R 16X14Mm Parall","code_information":[{"code":"7720900","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":21982.0,"discounted_cash":8792.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 24Mm 6-Hole Lck 2Lvl Ti Ant Cervical","code_information":[{"code":"7720901","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":1736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stapler Inter Echelon 3000 Lap Std 60Mm 34Cm Sgl-Hand Articulat Power 12-Firing","code_information":[{"code":"7720902","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":368.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Maloney Bougie 36Fr  Pwk507936","code_information":[{"code":"7720903","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":204.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reload Staple Echelon Endopath Gst Endo Linear Cutter 60Mm 2.6/1Mm Open/Closed Vasc Thin Tissue","code_information":[{"code":"7720904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reload Staple Echelon Endopath Gst Endo Linear Cutter 60Mm 3.6/1.5Mm Open/Closed Reg Tissue 6-Row","code_information":[{"code":"7720905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Transconnector Spinal Revere 33-41Mm Lo-Pro Adjust Ti T-Shaped F/5.5Mm Rod","code_information":[{"code":"7720906","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3775.0,"discounted_cash":1510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Joint Instrument 1.75In Short Tibial Triathlon Strt Headed","code_information":[{"code":"7720907","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 9 15Mm Dist 45Mm Offst 150Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7720908","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14604.0,"discounted_cash":5841.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur 26X43Mm Univ Bipol","code_information":[{"code":"7720909","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5052.0,"discounted_cash":2020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 5 Cement Primary Bead Cocr Knee","code_information":[{"code":"7720910","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11977.0,"discounted_cash":4790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 19Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7720911","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10999.0,"discounted_cash":4399.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill A.L.P.S 2.5Mm Strl F/Small Frag Frx Plate System","code_information":[{"code":"7720912","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill A.L.P.S 2.7Mm Calib F/Small Frag Frx Plate System","code_information":[{"code":"7720913","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 10-Hole Tubul Compress Lck Timax Anatomic Hybrid Foot F/3.5Mm Screw Ns","code_information":[{"code":"7720914","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X12Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7720915","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X14Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7720916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X16Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7720917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X10Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7720918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X12Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7720919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X12Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7720920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral Prem Sof-Curl 6Frx22Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Fig Four 7F 23-30 288407 Silicone","code_information":[{"code":"7720922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":191.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral Prem Sof-Curl 6Frx24Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Ureteral Prem Sof-Curl 6Frx26Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Ureteral Prem Sof-Curl 6Frx28Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Ureteral Prem Sof-Curl 7Frx22Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Ureteral Prem Sof-Curl 7Frx24Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Ureteral Prem Sof-Curl 7Frx26Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Ureteral Prem Sof-Curl 7Frx28Cm Dual Duromet Open End Firm Braid Nylon Tether Soft Bladder","code_information":[{"code":"7720929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Spinal Revere 5.5X65Mm Curve Non-Threaded Ti Alloy Thoracolum 124655","code_information":[{"code":"7720930","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Acu-Loc 2 2.3X16Mm Lck Perm Smooth Ti Dist Radial Volar Cortic Ns F/Plating System","code_information":[{"code":"7720931","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Acu-Loc 2 2.3X18Mm Lck Perm Smooth Ti Dist Radial Volar Cortic Ns F/Plating System","code_information":[{"code":"7720932","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pacemaker Cardiac Enpulse Adapta Dr Implant Unipol Bipol Std 47.9X44.7X7.5Mm 27.1Gm 2-Chamber Rate","code_information":[{"code":"7720933","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":22055.0,"discounted_cash":8822.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 28/28Mm P/D 140Mm Strt Woven Aortic Ext Cuff","code_information":[{"code":"7720934","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9052.0,"discounted_cash":3620.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X32Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720935","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X24Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7720936","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Clamp Extern Fixat 1.044X1.344In 50Deg Angle 360Deg Total Rotat Intermed Rod-Pin Cartridge Jet-X","code_information":[{"code":"7720937","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2238.0,"discounted_cash":895.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar Extern Fixat 6Mm Mini 225Mm Sm Bone Jet-X Carbon Fiber Ns","code_information":[{"code":"7720938","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 3Mm Short 15Mm Thread Ankle Foot Jet-X Ss Ti Nitride Ns","code_information":[{"code":"7720939","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hip Compo Peak Fx 100X140Mm Lag Assembly Ns","code_information":[{"code":"7720940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1532.0,"discounted_cash":612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 22/13Mm Aortic/Iliac 13.5Cm Bifurc Woven","code_information":[{"code":"7720941","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":29312.0,"discounted_cash":11724.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 13Mm P/D 11.5Cm Strt Woven Iliac Ext Cuff","code_information":[{"code":"7720942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11502.0,"discounted_cash":4600.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Sm 8X22X11Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720943","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin 5X30             7106-5308","code_information":[{"code":"7720944","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":247.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 1.5In Strt Multi Metaphyseal Diaphyseal Jet-X Anodized Alum Ti Ss F/10.5Mm","code_information":[{"code":"7720945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Foot Frame 180 7107-0145 Taylor","code_information":[{"code":"7720946","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5052.0,"discounted_cash":2020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring 180 Taylor      7107-0115","code_information":[{"code":"7720947","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5052.0,"discounted_cash":2020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Surg Proc T&A","code_information":[{"code":"7720948","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dowel Bone Graft 11Mm Allograft Cortic","code_information":[{"code":"7720949","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2174.0,"discounted_cash":869.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc Wide Contour Lck Lo-Pro Ti Lt Volar Dist Radius Blue Ns","code_information":[{"code":"7720950","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3382.0,"discounted_cash":1352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X60Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720951","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X70Mm Cannul 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X65Mm Cannul Lag 20Mm Full Thread Self-Drilling/Tapping Cortic Timax Biocompat Ns","code_information":[{"code":"7720953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Size D Unicompart High Flexion Zimaloy Lt Medial Rt Lat Knee","code_information":[{"code":"7720954","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12515.0,"discounted_cash":5006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X26X10Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7720955","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12446.0,"discounted_cash":4978.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 30Mm Narrow Contour Lck Lo-Pro Ti Lt Dist Volar Radial Blue Ns","code_information":[{"code":"7720956","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3382.0,"discounted_cash":1352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Acu-Loc 2 2.3X14Mm Lck Perm Smooth Ti Dist Radial Volar Cortic Ns F/Plating System","code_information":[{"code":"7720957","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X14Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7720958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X18Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7720959","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Im Polarus Plus 11X150Mm Cannul Lck Stability Prox Humeral Ti Strl","code_information":[{"code":"7720960","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7529.0,"discounted_cash":3011.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 5.3X40Mm Lck Full Thread Cancell Ti Humeral Strl","code_information":[{"code":"7720961","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":243.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 5.3X35Mm Lck Full Thread Cancell Ti Humeral Strl","code_information":[{"code":"7720962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":243.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X22.5Mm Cortic","code_information":[{"code":"7720963","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":243.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filler Bone Graft Promodel Inject Void 3Ml Strl","code_information":[{"code":"7720964","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3757.0,"discounted_cash":1502.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pacemaker Cardiac Reply Dr 2-Chamber Rate Respons","code_information":[{"code":"7720965","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":22229.0,"discounted_cash":8891.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Acutrak 2Mm 20In Ss Ns","code_information":[{"code":"7720966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.8Mm Short Tap Polarus","code_information":[{"code":"7720967","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Injector Bone Cement Delivery F/Callos","code_information":[{"code":"7720968","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":191.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 40X58Mm +4 Neutral 10Deg Angle Altrx","code_information":[{"code":"7720969","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10371.0,"discounted_cash":4148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 40Mm +1.5Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7720970","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5186.0,"discounted_cash":2074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 9-Hole Tubul Compress Lck Timax Lo-Pro Anatomic Hybrid Foot F/3.5Mm Screw Ns","code_information":[{"code":"7720971","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":299.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X10Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7720972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 34Mm 6-Hole Lck 2Lvl Ti Ant Cervical","code_information":[{"code":"7720973","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4340.0,"discounted_cash":1736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Jet-X Mini Qck-Conn Ns F/5Mm Half Pin","code_information":[{"code":"7720974","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":243.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 3X25Mm 65Mm Thread Ankle Foot Jet-X Ss Ti Nitride Ns","code_information":[{"code":"7720975","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Femur Articul/Eze -3Mm Neck Unipol 12/14 Taper Modul Cathcart Hip","code_information":[{"code":"7720976","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sphincterotome Endo Fusion Omni Preload 7Frx200Cm Cath 25Mm Cut Wire Dome Tip Cannul Mark V","code_information":[{"code":"7720977","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1671.0,"discounted_cash":668.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Acrobat Wire Guide      G47608","code_information":[{"code":"7720978","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.0,"discounted_cash":590.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sphincterotome Endo Fusion Omni Preload 5.5Frx200Cm Cath 25Mm Cut Wire Dome Tip Cannul Mark V","code_information":[{"code":"7720979","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Glo-Tip Ercp Cath 5.5 Gt-5-4-3","code_information":[{"code":"7720980","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon Extract Extractor Pro Rx Endo Retriev 7-6Fr Cath 12-15Mmx200Cm Square Shoulder 3Lumen Spec","code_information":[{"code":"7720982","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Balloon Extract Extractor Pro Rx Endo Retriev 7-6Fr Cath 15-18Mmx200Cm Square Shoulder 3Lumen Spec","code_information":[{"code":"7720983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Lithotriptor Handle      Slh-1","code_information":[{"code":"7720984","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lithotriptor Cable     Ttcl-10","code_information":[{"code":"7720985","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Basket Trapezoid 3.0Cm    1089","code_information":[{"code":"7720986","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1134.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dilator Endo Fusion Titan 12Frx4Mm Bln 190Cm 4Cm Biliary Lo-Pro Multi-Port Cath Purple F/Tree","code_information":[{"code":"7720987","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":377.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon Dilation 6Mmx4Cm 49220 Fs-Bdb-6X4","code_information":[{"code":"7720988","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":377.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Brush Cytology Infinity Endo 9Fr Sheath 200Cm Stiff Bristle Detach Hndl Sampling Device Nitinol","code_information":[{"code":"7720989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Device Inflat Quantum Endo 20Ml Syringe Biliary W/Glow In Dark Gauge Label F/Tcc Bln Dilator Strl","code_information":[{"code":"7720990","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Endo Fusion Device Lck Built-In Cap F/Olympus Fujinon Scope Strl Disp Biliary Pancreatic","code_information":[{"code":"7720991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":137.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Bili 7Fr X 7Cm  Clso-7-7","code_information":[{"code":"7720992","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bili Stent 7F X 10Cm Clso-7-10","code_information":[{"code":"7720993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary Cotton-Leung 7Frx12Cm Prox/Dist Flap Curve Taper Tip Pe Bile Duct Purple 0.035In Gw","code_information":[{"code":"7720994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bili Stent 10F X 5Cm Clso-10-5","code_information":[{"code":"7720995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary Cotton-Leung 10Frx7Cm Prox/Dist Flap Curve Taper Tip Pe Bile Duct Purple 0.035In Gw","code_information":[{"code":"7720996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary Cotton-Leung 10Frx10Cm Prox/Dist Flap Curve Taper Tip Pe Bile Duct Purple 0.035In Gw","code_information":[{"code":"7720997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bili Stent 10Fx12Cm Clso-10-12","code_information":[{"code":"7720998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Sling Urological Advance Xp Retrourethral F/Stress Urinary Incontinence Male 3Yr Shelf Life Us","code_information":[{"code":"7720999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":15460.0,"discounted_cash":6184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Triathlon Size 8 19Mm Artic Surface C/R Fixed Bearing X3 F/Total Knee Arthropl","code_information":[{"code":"7721000","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5422.0,"discounted_cash":2168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Reflex 18Mm 4-Hole 2.1Mm Lo-Pro Lck Hybrid 1Lvl 1-Step Ti Curve Contour Ant Cervical","code_information":[{"code":"7721001","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7589.0,"discounted_cash":3035.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain Sm 10X22X9Mm Self-Distract Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7721002","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8485.0,"discounted_cash":3394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Transmitter Pacemaker Instromedix Landline","code_information":[{"code":"7721003","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 6.4X95Mm Lck Inter Captured Cortic Ti Hex Head Blue Im Reconstruct F/Antegrade","code_information":[{"code":"7721004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":495.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X320Mm 130Deg Angle Cannul Lck Antegrad Lt Femur Trochan Ti Alloy Lime","code_information":[{"code":"7721005","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7903.0,"discounted_cash":3161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X340Mm 130Deg Angle Cannul Lck Antegrad Lt Femur Trochan Ti Alloy Lime","code_information":[{"code":"7721006","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7903.0,"discounted_cash":3161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pacemaker Cardiac Adapta Dr Implant Unipol Bipol Sm 42.9X44.7X7.5Mm 11.1Cm3 2-Chamber Rate Respons","code_information":[{"code":"7721007","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":22055.0,"discounted_cash":8822.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Lead Neurostim Interstim Unipol Sacral Nerve W/Patient/2-Test Cable 3-Needle 4-Drape 2-Pvp Pack","code_information":[{"code":"7721008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":11013.0,"discounted_cash":4405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Lead Neurostim Intro Direct Guide Dilator Sheath F/Interstim System Pt Programmer Carrying Case","code_information":[{"code":"7721009","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2833.0,"discounted_cash":1133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 7 11Mm Dist 39Mm Offst 130Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7721010","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16023.0,"discounted_cash":6409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Reflexion Lg Metatarsal","code_information":[{"code":"7721011","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3723.0,"discounted_cash":1489.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reamer Surg Sharps Wire 001-0103","code_information":[{"code":"7721012","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":815.0,"discounted_cash":326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Pca Sm 11Mm Rt Modul Revis Porous","code_information":[{"code":"7721013","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8317.0,"discounted_cash":3326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sling Gyn W/Tension Suture","code_information":[{"code":"7721014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":3946.0,"discounted_cash":1578.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Elbow Joint 7X25Mm +4Mm Offst Collar Ti Radial F/Arh Solutions 2 System Strl","code_information":[{"code":"7721015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9787.0,"discounted_cash":3914.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Elbow Joint 24Mm 4Deg Angle Anatomic Ti Rt Radial F/Arh Solutions 2 System Strl","code_information":[{"code":"7721016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8659.0,"discounted_cash":3463.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Versanail 12Mm Univ 250Mm Cannul Lck Tibiotalocalcaneal Ankle Ti Alloy Strl","code_information":[{"code":"7721017","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7307.0,"discounted_cash":2922.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Global Fx 12X120Mm Eccentric Modul Cocr Porous","code_information":[{"code":"7721018","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13347.0,"discounted_cash":5338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Balloon 7X16 Bco716Rs Sinus","code_information":[{"code":"7721019","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1727","type":"HCPCS"}],"standard_charges":[{"gross_charge":2811.0,"discounted_cash":1124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Talar Fit 11Mm        340-0004","code_information":[{"code":"7721020","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5198.0,"discounted_cash":2079.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 226Mm 12-Hole Contour Lck Timax Rt Medial Dist Tibial F/3.5Mm Screw Ns","code_information":[{"code":"7721021","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5247.0,"discounted_cash":2098.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X22Mm Cancell","code_information":[{"code":"7721022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X30Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X34Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X36Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X40Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X16Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X22Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X24Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X36Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X38Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X44Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 440Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7721033","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7639.0,"discounted_cash":3055.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 11Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7721034","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5723.0,"discounted_cash":2289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe Electrosurgical Fiapc 2.3Mm/6.9Frx220Cm Filter Integrate 2200 A Strl Disp F/Argon Plasma Coag","code_information":[{"code":"7721035","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":295.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Probe Electrosurgical Fiapc Circ 2.3Mmx220Cm Filter Integrate 2200 C Strl Disp F/Argon Plasma Coag","code_information":[{"code":"7721036","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":757.0,"discounted_cash":302.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pump Tubing/Cap Set Eip2 24 Hour Use Gi       20325-201","code_information":[{"code":"7721037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Pancreatic Geenen 5Frx5Cm Spiral Side Hole No Inter Flap Taper Tip Contour Pe Blue 0.035In Gw","code_information":[{"code":"7721038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Anchor Suture Quickanchor Plus 1.3Mm Micro Preload Nonabsorbable W/#4/0 Ethibond C-1 Drill Bit","code_information":[{"code":"7721039","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 16Mm 4-Hole Lck 1Lvl Ti Ant Cervical","code_information":[{"code":"7721040","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3965.0,"discounted_cash":1586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Facial Band Universal     210U Cotton Lining","code_information":[{"code":"7721041","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl 11X25X12Mm Peek Vertebral 0Deg Rect","code_information":[{"code":"7721042","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17380.0,"discounted_cash":6952.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast 12.8-13.6Cm 4-4.8Cm Moderate-Profile 375-425Ml Saline-Filled Smooth Ant Diaphragm Vlv","code_information":[{"code":"7721043","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2268.0,"discounted_cash":907.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast 14.5-15Cm 4.2-5.1Cm Moderate-Profile 525Ml Saline-Filled Smooth Ant Diaphragm Vlv","code_information":[{"code":"7721044","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2268.0,"discounted_cash":907.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Cell 1Cc          35-2001 Trinity","code_information":[{"code":"7721045","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":698.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Cell 5Cc          35-2005 Trinity","code_information":[{"code":"7721046","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7754.0,"discounted_cash":3101.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Cell 15Cc         35-2015 Trinity","code_information":[{"code":"7721047","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20349.0,"discounted_cash":8139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X26X13Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7721048","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Prosthesis Penile Ams 800 Urine Control System Blunt Needle Sphincter W/Connector Cuff 30Cm","code_information":[{"code":"7721049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":698.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 5X38Mm Spinal Round Fine 60-70-Grit E9000 Diamond Strl F/Otology Neuro","code_information":[{"code":"7721050","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 7.3X95Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Cortic Ss","code_information":[{"code":"7721051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X85Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X95Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X35Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X75Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X26X15Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7721056","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Hemostat Bipol Electro Hemost Gold Probe 10Frx300Cm Std Connector/Plug Strl Disp 3.7Mm","code_information":[{"code":"7721057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 5X90Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 7.3X90Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Cortic Ss","code_information":[{"code":"7721059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.0,"discounted_cash":400.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Ibex 7Mm Pyramid Tooth Peek Cervical 0Deg Lordot Contour Ns","code_information":[{"code":"7721060","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19727.0,"discounted_cash":7890.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Ibex 9Mm Pyramid Tooth Peek Cervical 0Deg Lordot Contour Ns","code_information":[{"code":"7721061","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19727.0,"discounted_cash":7890.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Array 5.5X510Mm Curve Smooth Cp Ti","code_information":[{"code":"7721062","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1595.0,"discounted_cash":638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clippers Sterile     Dynd70842","code_information":[{"code":"7721063","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peak Fx 4-Hole Compress Ti Std Barrel Ns","code_information":[{"code":"7721065","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hip Compo Peak Fx 110X130Mm Lag Assembly Ns","code_information":[{"code":"7721066","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Key Surg Assembly Peek Fx","code_information":[{"code":"7721067","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X40Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue 10X26X26Mm Frozen Cortic Ant Lumb Lordot","code_information":[{"code":"7721069","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13643.0,"discounted_cash":5457.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X6Mm Cruciform Recess Cortic Ti Full Thread Self-Tap Gold F/Modular Mini Frag System","code_information":[{"code":"7721070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 11Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7721071","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 10Mm Std 330Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7721072","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5458.0,"discounted_cash":2183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Staple Memory 20X20 Lrg  17622 2X3Mm Biopro","code_information":[{"code":"7721073","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":438.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3Mm Lg F/Staple","code_information":[{"code":"7721074","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.7X6Mm Cruciform Recess Emergency Cortic Ti Full Thread Self-Tap Silver Mandibular Ns","code_information":[{"code":"7721075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl Unilif 11X30X9Mm Peek Post Lumb 0Deg Lordot Wedge","code_information":[{"code":"7721076","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22946.0,"discounted_cash":9178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 6Mm 44X214Mm 3-Hole Angle Contour Lck Ti Reconstruct F/Pspc Rt Cmf","code_information":[{"code":"7721077","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15778.0,"discounted_cash":6311.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 100X100Mm 0.4Mm Square Contour Mesh Ti Malleab Teal F/1.5Mm Screw Cranfac Strl","code_information":[{"code":"7721078","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6692.0,"discounted_cash":2676.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 6.5X80Mm Cannul Compress Lck 16Mm Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7721079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 7.3X85Mm Cannul Compress Lck 16Mm Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7721080","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":377.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 6.5X50Mm Cannul Compress Lck 32Mm Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7721081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X16Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721082","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X32Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Signature Sm 10X28X12Mm Peek Transforaminal Lumb","code_information":[{"code":"7721084","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Size 8 140Mm Cementls Collar Ti Arc Hap Plasma Spray 132Deg Angle Hip","code_information":[{"code":"7721085","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14974.0,"discounted_cash":5989.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Gastrostomy Mic Feeding 26Fr 7-10Ml Bln Adult Gastric Jejunal Enteral Recess Atraum Dist Tip","code_information":[{"code":"7721086","type":"CDM"},{"code":"272","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Jl3.5 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7721087","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone 2-Hole Congruent Lck Ti Extend Olecranon Elbow Ns","code_information":[{"code":"7721088","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3511.0,"discounted_cash":1404.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Wire 2.0 Mm X 9 Inches                       Ws2009St","code_information":[{"code":"7721089","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill 2.8 Mm Long     Ms.Ldc28 Quick Release Drill","code_information":[{"code":"7721090","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 3.5 Mm X 18 Mm  Col.3180 Cortical Locking Screw","code_information":[{"code":"7721091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X28Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7721092","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 3.5 Mm X 24 Mm   Co.3240 Cortical Screw","code_information":[{"code":"7721093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 4X16Mm Cancell Ti Hex Head Ns","code_information":[{"code":"7721094","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 4X18Mm Cancell Ti Hex Head Ns","code_information":[{"code":"7721095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X36Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721096","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":329.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X30Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":329.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Elbow Joint 22Mm 4Deg Angle Anatomic Ti Rt Radial F/Arh Solutions 2 System Strl","code_information":[{"code":"7721098","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8090.0,"discounted_cash":3236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pacemaker Cardiac Zephyr Xl Dr Implant 10.4Ml 2-Chamber Rate Respons Strl Ppm","code_information":[{"code":"7721099","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":23641.0,"discounted_cash":9456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Lead Safesheath 6Frx13Cm Fixed Curve Peel-Away Hemostat Vlv Sidept W/45Cm Gw 20Cm Dilator","code_information":[{"code":"7721100","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak Mini 26Mm Cannul Compress Headless Full Thread Self-Tap Ti Hex Drive Strl","code_information":[{"code":"7721101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.0,"discounted_cash":587.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 6-Hole Pin Quick-Coupling Dist Radial Foot Jet-X F/Unilateral Bar System Ns","code_information":[{"code":"7721102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1953.0,"discounted_cash":781.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X125Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7721103","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":354.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X26X13Mm Self-Distract Peek Ti Thoracolum Oblique","code_information":[{"code":"7721104","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Transconnector Spinal Revere 38-51Mm Lo-Pro Adjust Ti T-Shaped F/5.5Mm Rod","code_information":[{"code":"7721105","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Signature Sm 10X28X10Mm Peek Transforaminal Lumb","code_information":[{"code":"7721106","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Long Micro 1.9Mm X 34Mm Long Micro Drill       80.0100","code_information":[{"code":"7721107","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":347.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 14 Mm Micro    At2.C14.S Micro Acutrak Ii Screw","code_information":[{"code":"7721108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":657.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Providence 12Mm 4-Hole Lck 1Lvl Ti Ant Cervical","code_information":[{"code":"7721109","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3705.0,"discounted_cash":1482.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Pilot 1.5X125Mm Maxillofacial J-Latch Coupl Ss Ns F/Lcp Modul Hand System","code_information":[{"code":"7721110","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X14Mm Cortic Ti Self-Tap Coarse Pitch Gold F/Curvilinear Distract System Cmf","code_information":[{"code":"7721111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Mini 20-Hole Strt Lck Ti Adaption F/2Mm Screw Mandibular Ns","code_information":[{"code":"7721112","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2040.0,"discounted_cash":816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal X-Stop 14Mm Ipd Peek F/Interbody Fusion","code_information":[{"code":"7721113","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17090.0,"discounted_cash":6836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Global Advantage 10Mm Std 135Mm Cementls Ti Porous Prox","code_information":[{"code":"7721114","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14976.0,"discounted_cash":5990.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal X-Stop 12Mm Ipd Peek F/Interbody Fusion","code_information":[{"code":"7721115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17090.0,"discounted_cash":6836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Signature Sm 10X28X13Mm Peek Transforaminal Lumb","code_information":[{"code":"7721116","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Signature Sm 10X28X15Mm Peek Transforaminal Lumb","code_information":[{"code":"7721117","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 44Mm 2Lvl Ti Extra Lordot Ant Cervical","code_information":[{"code":"7721118","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Vip 4.6X14Mm Self-Drill Var Ang Ti Ant Cervical","code_information":[{"code":"7721119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":354.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Variax 2.3X18Mm Non-Locking Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti T7","code_information":[{"code":"7721120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 50Mm Std Contour Lck Lo-Pro Ti Rt Volar Dist Radius Green Ns","code_information":[{"code":"7721121","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pump Penile Ams 700 Lgx 12Mmx15Cm Saline-Filled Inflate Pre-Connected Infrapubic Cylindr","code_information":[{"code":"7721122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":23360.0,"discounted_cash":9344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 15Mm 1Lvl Ti Extra Lordot Ant Cervical 171.115","code_information":[{"code":"7721124","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":2115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size F 36Mm 54-56Mm 10Deg Angle Primary Crossfire Strl","code_information":[{"code":"7721125","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4006.0,"discounted_cash":1602.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Signature Sm 10X28X9Mm Peek Transforaminal Lumb","code_information":[{"code":"7721126","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 24/14Mm P/D 170Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721127","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30387.0,"discounted_cash":12154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14Mm P/D 105Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721128","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14007.0,"discounted_cash":5602.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 22/14Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721129","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29685.0,"discounted_cash":11874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 16/16Mm P/D 80Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721130","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13304.0,"discounted_cash":5321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/18Mm P/D 90Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721131","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14535.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/16Mm P/D 105Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721132","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14007.0,"discounted_cash":5602.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Zero-P 9Mm Var Ang Std Preassembled Tooth Peek-Optima Ti Plate Ant Cervical Lordot","code_information":[{"code":"7721133","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12864.0,"discounted_cash":5145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Zero-P 3X16Mm Lck Trilobular Thread Self-Tapping/Centering Cancell Ti Conical Head Blue","code_information":[{"code":"7721134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":354.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 2Mm Ant Cervical Quick-Coupling W/16Mm Stop Ss Ns","code_information":[{"code":"7721135","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 2Mm Ant Cervical Quick-Coupling W/12Mm Stop Ss Ns","code_information":[{"code":"7721136","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Signature Sm 10X28X11Mm Peek Transforaminal Lumb","code_information":[{"code":"7721137","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 30Mm 2Lvl Ti Extra Lordot Ant Cervical 171.230","code_information":[{"code":"7721138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X26X12Mm Self-Distract Peek Ti Thoracolum Oblique","code_information":[{"code":"7721139","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Retain R 16X14Mm Convex","code_information":[{"code":"7721140","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20544.0,"discounted_cash":8217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Retain R 16X12Mm Convex","code_information":[{"code":"7721141","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20544.0,"discounted_cash":8217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture 6-0 Mono P-1 Cut  Y489G","code_information":[{"code":"7721142","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Ncb 2.5X180Mm Dist Femur 2-Flute Qck-Conn W/O Stop Radiolucent Ns Reus","code_information":[{"code":"7721143","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":182.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Ncb 132Mm 3/5-Hole Lck Ti Non-Cont Bridge Rt Lat Prox Tibial F/Universal System Ns","code_information":[{"code":"7721144","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5284.0,"discounted_cash":2113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X48Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7721145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 5X70Mm Non-Cannulated Non-Locking 32Mm Partial Thread Polyaxial Self-Tap Cancell","code_information":[{"code":"7721146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 5X75Mm Non-Cannulated Non-Locking 32Mm Partial Thread Polyaxial Self-Tap Cancell","code_information":[{"code":"7721147","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 5X65Mm Non-Cannulated Non-Locking 32Mm Partial Thread Polyaxial Self-Tap Cancell","code_information":[{"code":"7721148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X44Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X48Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X50Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Stent 36/18Mm P/D 170Mm Bifurc","code_information":[{"code":"7721152","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":32503.0,"discounted_cash":13001.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/18Mm P/D 105Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721153","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15241.0,"discounted_cash":6096.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 20Mm P/D 79Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721154","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13304.0,"discounted_cash":5321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Signature Sm 10X28X8Mm Peek Transforaminal Lumb","code_information":[{"code":"7721155","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 44X214Mm 6/23-Hole Angle Contour Lck Ti Reconstruct F/2.4Mm Screw Lt Cmf","code_information":[{"code":"7721156","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17925.0,"discounted_cash":7170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X8Mm Cruciform Recess Cortic Ti Full Thread Self-Tap Gold F/Modular Mini Frag System","code_information":[{"code":"7721157","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Size 13 170Mm Cementls Collar Ti Arc Hap Plasma Spray 132Deg Angle Hip","code_information":[{"code":"7721158","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":24175.0,"discounted_cash":9670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X36Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14Mm P/D 90Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721160","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13304.0,"discounted_cash":5321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 36/20Mm P/D 155Mm Bifurc Woven Aortic Ext Slf-Expand Closed","code_information":[{"code":"7721161","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":33032.0,"discounted_cash":13212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Unitrax 56Mm Endo Unipol Compo Primary Modul Cocr Hip Strl","code_information":[{"code":"7721162","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":505.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Unitrax V40 +5Mm Neck Unipol Adjust C-Tapered 5Deg Primary Modul Hip","code_information":[{"code":"7721163","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Lcp 1.5X85Mm Maxillofacial J-Latch End Cannul W/60Mm Stop Ss Ns","code_information":[{"code":"7721164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Mini 4-Hole Tension Band Narrow Lck Ti F/2Mm Screw Mandibular Ns","code_information":[{"code":"7721165","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1266.0,"discounted_cash":506.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Avs Pl Unilif 11X30X10Mm Peek Post Lumb 0Deg Lordot Wedge","code_information":[{"code":"7721166","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20649.0,"discounted_cash":8259.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Retain R 16X10Mm Convex","code_information":[{"code":"7721167","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20544.0,"discounted_cash":8217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mask Nebulizer Aeroeclipse Aero Lg Elong Soft Flex Head Strap Clear Unscent Silicone Lf Disp","code_information":[{"code":"7721168","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Hip Compo Peak Fx 90X135Mm Lag Assembly Ns","code_information":[{"code":"7721169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spatula Surg 7 7/8In 10Mm Blade Brain Flat Dbl-End Malleab Silicone Coat Disp","code_information":[{"code":"7721170","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Generator Neurostim Eon Mini 53X48Mm 10Mm 16-Channel Spinal Cord W/Port 2-Plug Torq Wrench Pocket","code_information":[{"code":"7721171","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":63393.0,"discounted_cash":25357.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Lead Neurostim Lamitrode Tripole 16 1.4Mmx60Cm 1Mm/3Mm Space 10X57Mm Paddle Implant 16-Electrode","code_information":[{"code":"7721172","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":20789.0,"discounted_cash":8315.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Programmer Neurostim Eon Pt Recharge","code_information":[{"code":"7721173","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":4919.0,"discounted_cash":1967.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Programmer Neurostim Eon Mini Charger Belt W/Accessories","code_information":[{"code":"7721174","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4919.0,"discounted_cash":1967.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 6.5X85Mm Cannul Compress Lck 16Mm Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7721175","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":393.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 4X80Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721176","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":227.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X80Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721177","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":227.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X60Mm 100Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721178","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":227.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X80Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721179","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":227.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Vasc Protege Everflex 7X20Mm 80Cm Slf-Expand 0.035In Gw 6Fr Sheath Entrust Spiral Cell","code_information":[{"code":"7721180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Vasc Protege Everflex 7X40Mm 80Cm Slf-Expand 0.035In Gw 6Fr Sheath Entrust Spiral Cell","code_information":[{"code":"7721181","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vasc Protege Everflex 7X60Mm 80Cm Otw Slf-Expand Pre-Mount Nitinol Iliac Superficial","code_information":[{"code":"7721182","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Vasc Protege Everflex 7X80Mm 80Cm Slf-Expand 0.035In Gw 6Fr Sheath Entrust Spiral Cell","code_information":[{"code":"7721183","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Vasc Protege Everflex 8X20Mm 80Cm Slf-Expand 0.035In Gw 6Fr Sheath Entrust Spiral Cell","code_information":[{"code":"7721184","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Verte-Stack 14X11X7Mm Anatomic Peek Ant Cervical","code_information":[{"code":"7721185","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6344.0,"discounted_cash":2537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Atlantis Vision 40Mm Lck Ti Ant Cervical","code_information":[{"code":"7721186","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6795.0,"discounted_cash":2718.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Atlantis 4.5X13Mm Self-Drill Var Ang Cancell Ti Ant Cervical Ns","code_information":[{"code":"7721187","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":681.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shoe Post-Op Rocker Semi-Rigid Sm Size 6-8 Female Open Toe Pitch Heel Loop-Lock Close Remov Tongue","code_information":[{"code":"7721188","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shoe Post-Op Rocker Semi-Rigid Med 3.5X10.5In Size 8.5-10 Women Open Toe Pitch Heel Loop-Lock Close","code_information":[{"code":"7721189","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shoe Post-Op Rocker Semi-Rigid Lg Size 10.5-12 Female Open Toe Pitch Heel Loop-Lock Close Remov","code_information":[{"code":"7721190","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shoe Post-Op Rocker Semi-Rigid Sm Size 6-8 Male Open Toe Pitch Heel Loop-Lock Close Remov Tongue","code_information":[{"code":"7721191","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shoe Post-Op Rocker Semi-Rigid Med Size 8.5-10 Male Open Toe Pitch Heel Loop-Lock Close Remov Tongue","code_information":[{"code":"7721192","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shoe Post-Op Rocker Semi-Rigid Lg Size 10.5-12 Male Open Toe Pitch Heel Loop-Lock Close Remov Tongue","code_information":[{"code":"7721193","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shoe Post-Op Rocker Semi-Rigid Xl Size 12.5-15 Male Open Toe Pitch Heel Loop-Lock Close Remov Tongue","code_information":[{"code":"7721194","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Spinal Vip 32Mm 2Lvl Ti Extra Lordot Ant Cervical 171.232","code_information":[{"code":"7721195","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Spinal Vip 13Mm 1Lvl Ti Extra Lordot Ant Cervical 171.113","code_information":[{"code":"7721196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":2115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Signature Sm 10X28X7Mm Peek Transforaminal Lumb","code_information":[{"code":"7721197","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15855.0,"discounted_cash":6342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X51Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7721198","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3251.0,"discounted_cash":1300.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pusher Knot Ultra Fast-Fix Arthro Strt W/Suture Cutter Meniscal Strl Disp","code_information":[{"code":"7721199","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Delivery Syst Cannula 72201494 Ultra Fast Fix Ab Curvd Needl","code_information":[{"code":"7721200","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":438.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 12Mm P/D 81Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721201","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13304.0,"discounted_cash":5321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 30/14Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721202","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":32503.0,"discounted_cash":13001.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Stent","code_information":[{"code":"7721203","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15062.0,"discounted_cash":6024.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/14Mm P/D 80Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721204","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13304.0,"discounted_cash":5321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/5-6 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7721205","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6260.0,"discounted_cash":2504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheath Urological Uropass Access 12X14Fr 6-12Fr Dilator 24Cm Ureteral Taper Tip Dual Duromet Funnel","code_information":[{"code":"7721206","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sheath Urological Uropass Access 12X14Fr 6-12Fr Dilator 38Cm Ureteral Taper Tip Dual Duromet Funnel","code_information":[{"code":"7721207","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sheath Urological Uropass Access 12X14Fr 6-12Fr Dilator 54Cm Ureteral Taper Tip Dual Duromet Funnel","code_information":[{"code":"7721208","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Hps 4X36Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.0,"discounted_cash":320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Fistula            G53614 Anocutaneous .6 X 9.5 Cm","code_information":[{"code":"7721210","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3086.0,"discounted_cash":1234.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 28Mm 2Lvl Ti Extra Lordot Ant Cervical 171.228","code_information":[{"code":"7721211","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 14.4Cm 5.7Cm Hp 650Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7721212","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":3267.0,"discounted_cash":1306.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Elbow Joint 7X25Mm +2Mm Offst Collar Ti Radial F/Arh Solutions 2 System Strl","code_information":[{"code":"7721213","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9499.0,"discounted_cash":3799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Embolic Protect Spiderfx 4Mm Loop Braid Carotid Artery W/Filter System Nitinol Gold Tungsten","code_information":[{"code":"7721214","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4408.0,"discounted_cash":1763.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 34Mm 2Lvl Ti Extra Lordot Ant Cervical","code_information":[{"code":"7721215","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 5 10Mm Unicompart Pe Rt Medial Lt Lat","code_information":[{"code":"7721216","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6052.0,"discounted_cash":2420.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Hi-Torque Whisper View Eds 0.014Inx190Cm Coronary Sinus J-Tip","code_information":[{"code":"7721217","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Acuity Mailman Ironman 0.014Inx182Cm Strt Tip Vein","code_information":[{"code":"7721218","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reinforcement Staple Line Gore Seamguard 3.5X45Mm Roticulator Blue Synthetic F/Medtronic Endo Gia","code_information":[{"code":"7721219","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":273.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X14Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 92Mm 7-Hole Lck Timax Dist Fibula Composite Ns","code_information":[{"code":"7721221","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Port Power 9.6 Fr      1859601 Silicone-Mediport","code_information":[{"code":"7721222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2004.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Dressing Ear Glasscock Surg 3.5X6In Ped Postauricular Lt/Rt Curve Custom Mold Non-Adhesive","code_information":[{"code":"7721223","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Bone Marrow Aspirat Imbibe 11Ga 6In Bullet Tip Strl","code_information":[{"code":"7721224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":184.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hip Compo Peak Fx 80X130Mm Lag Assembly Ns","code_information":[{"code":"7721225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Gore-Tex 5-0 30In 3/8 Circ Taper Point White 6M04A Monofil Eptfe 13Mm Nonabsorbable","code_information":[{"code":"7721226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Goretex Suture           6M10A Needle Size Ttc13","code_information":[{"code":"7721227","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extractor Surg 3.5Mm Long Hex","code_information":[{"code":"7721228","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":281.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X28Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7721229","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Polyax 233.5Mm 9-Hole Lck Timax Lt Dist Femur Ns","code_information":[{"code":"7721230","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Trigen Intertan 3.2Mm 343Mm Thread Trocar Tip Im","code_information":[{"code":"7721231","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":223.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta 10X360Mm Cannul Lck Retrograd Multi-Planar Dist Femur Ti Alloy Gold Strl","code_information":[{"code":"7721232","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7085.0,"discounted_cash":2834.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Trigen Meta-Nail 0Mm Ext Set Screw","code_information":[{"code":"7721233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 12 16Mm Dist 52Mm Offst 170Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7721234","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13648.0,"discounted_cash":5459.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 13Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7721235","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 6-Hole Ti Shortening Ulnar Strl","code_information":[{"code":"7721236","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3863.0,"discounted_cash":1545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Polyax 287.6Mm 12-Hole Lck Timax Lt Dist Femur Ns","code_information":[{"code":"7721237","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1854.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X18Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7721238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X55Mm Non-Locking Partial Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7721239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X50Mm Non-Locking Partial Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7721240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4.5Mm Solid","code_information":[{"code":"7721241","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Stent 26/16Mm P/D 140Mm Bifurc","code_information":[{"code":"7721242","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29685.0,"discounted_cash":11874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14Mm P/D 75Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721243","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12599.0,"discounted_cash":5039.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 8 Cementls C/R Bead Rt","code_information":[{"code":"7721244","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9473.0,"discounted_cash":3789.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 25Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7721245","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 8 9Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7721246","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Vip 4.6X12Mm Self-Drill Var Ang Ti Ant Cervical","code_information":[{"code":"7721247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":354.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Flexhd Ultra Thk 12X12Cm 1.8+Mm Frz-Dry Hydrat Acell Dermal Mesh Structur","code_information":[{"code":"7721248","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":18249.0,"discounted_cash":7299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Separator Bladeless Optical 12X150Mm Thread Stability Sleeve Insufflat Port","code_information":[{"code":"7721249","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":86.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Fios Bladeless Optical 12X100Mm Z-Threaded Sleeve Blunt Tip Lf Strl Abdomin","code_information":[{"code":"7721250","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Mesh Hernia C-Qur 15X20  31533","code_information":[{"code":"7721251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2567.0,"discounted_cash":1026.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2.4X34Mm Cannul Lag Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Hps 0.035X6In Kirschner Temp Dbl Trocar Point Ss F/2/2.4Mm Screw","code_information":[{"code":"7721253","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 5Mm Short 110Mm 45Mm Thread Ankle Foot Jet-X Ss Ti Nitride Ns","code_information":[{"code":"7721254","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bar 400Mm            7106-2400","code_information":[{"code":"7721255","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":376.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Bladeless Optical 5X100Mm Non-Threaded Abdomin Access","code_information":[{"code":"7721256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 320Mm 125Deg Angle Lck Lt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7721257","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7138.0,"discounted_cash":2855.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 26Mm 2Lvl Ti Extra Lordot Ant Cervical","code_information":[{"code":"7721258","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trocar Endo 12X100Mm W/Handle","code_information":[{"code":"7721259","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X5Mm Cruciform Recess Lck Cortic Ti Full Thread Self-Tap Dark Blue Cmf Ns","code_information":[{"code":"7721260","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Size 10 160Mm Cementls Collar Ti Arc Hap Plasma Spray 132Deg Angle Hip","code_information":[{"code":"7721261","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14974.0,"discounted_cash":5989.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Transmitter Pacemaker Pacetrak W/Pulse Width Mercury-Free Wrist Electrode Data","code_information":[{"code":"7721262","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":227.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Matrixneuro 2X12Mm Cruciform Head Ss Thread Self-Drill Cmf Ns","code_information":[{"code":"7721263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Screwdriver Plusdrive 1.5X2X96Mm Cranfac Hex Coupl Self-Retaining Lf Ns F/2/2.4Mm Screw","code_information":[{"code":"7721264","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":674.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X10Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7721265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X8Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7721266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X40Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X70Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X65Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Emerge 2.8Mm 300Mm Flute Calibrat Ns","code_information":[{"code":"7721270","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hip Compo Peak Fx 90X130Mm Lag Assembly Ns","code_information":[{"code":"7721271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Mantis 6X130Mm Curve Hex Ti Thoracolum Malleab Min Radius Ns Laser Etch","code_information":[{"code":"7721272","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2919.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 4 10Mm Unicompart Pe Rt Medial Lt Lat","code_information":[{"code":"7721273","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6052.0,"discounted_cash":2420.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Sm 11X14X7Mm Peek Cervical 5Deg Lordot","code_information":[{"code":"7721274","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4566.0,"discounted_cash":1826.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Helix Mini 36Mm 2Lvl Ti Ant Cervical Ns","code_information":[{"code":"7721275","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4648.0,"discounted_cash":1859.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Helix Mini Acp 4X13Mm Self-Drill Var Ang Ti","code_information":[{"code":"7721276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1189.0,"discounted_cash":475.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/18Mm P/D 75Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721277","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13834.0,"discounted_cash":5533.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 28/14Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721278","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29685.0,"discounted_cash":11874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 13Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7721279","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Gamma3 10.5X115Mm Lag Thread Self-Tap Ti 180Deg Trochan F/Long Nail System Strl","code_information":[{"code":"7721280","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1862.0,"discounted_cash":744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 300Mm 125Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7721281","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7138.0,"discounted_cash":2855.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hip Compo Peak Fx 100X130Mm Lag Assembly Ns","code_information":[{"code":"7721282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X38Mm Lck Full Thread Polyaxial Self-Tap Fixed Angle Cortic Ti Gold Dist Femur","code_information":[{"code":"7721283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peak Fx 3-Hole Compress Ti Ns","code_information":[{"code":"7721284","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1115.0,"discounted_cash":446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral Inlay Optima 6Frx22Cm Soft Dbl Pig Taper Polymer Blend W/Hydroglide Gw","code_information":[{"code":"7721285","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral Inlay Optima 6Frx24Cm Soft Dbl Pig Taper Polymer Blend W/Hydroglide Gw","code_information":[{"code":"7721286","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral Inlay Optima 7Frx24Cm Soft Dbl Pig Taper Polymer Blend W/Hydroglide Gw","code_information":[{"code":"7721287","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral Inlay Optima 7Frx22Cm Soft Dbl Pig Taper Polymer Blend W/Hydroglide Gw","code_information":[{"code":"7721288","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Independence 5.5X25Mm Var Ang Ti Ant Cervical","code_information":[{"code":"7721289","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":1024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Med 34X15X26Mm 8Deg Lordot","code_information":[{"code":"7721290","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":38139.0,"discounted_cash":15255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Citadel 26Mm Lo-Pro 1Lvl Ti Ant Lumbosacral","code_information":[{"code":"7721291","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17168.0,"discounted_cash":6867.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Citadel 6.5X26Mm Self-Tap Var Ang Ti Ant Lumb Streamlined Ns","code_information":[{"code":"7721292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2715.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Independence Strt Self-Centering","code_information":[{"code":"7721293","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1415.0,"discounted_cash":566.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sling Gyn Supris 0.3Mm Pp Low Elasticity Macroporous Knit Monofil Mid-Urethral Suprapubic W/2-Arc","code_information":[{"code":"7721294","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X36Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721295","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X38Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721296","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X40Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721297","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X42Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721298","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X44Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X46Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X28Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X28Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Zero-P 7Mm Var Ang Std Preassembled Tooth Peek-Optima Ti Plate Ant Cervical Lordot","code_information":[{"code":"7721303","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12864.0,"discounted_cash":5145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Zero-P 8Mm Var Ang Std Preassembled Tooth Peek-Optima Ti Plate Ant Cervical Lordot","code_information":[{"code":"7721304","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12864.0,"discounted_cash":5145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shaft Screwdriver Ant Cervical T8 Self-Holding Ns F/18Mm Screw","code_information":[{"code":"7721305","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Helix Mini 40Mm 2Lvl Ti Ant Cervical Ns","code_information":[{"code":"7721306","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4648.0,"discounted_cash":1859.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Sm 11X14X8Mm Peek 5Deg Lordot","code_information":[{"code":"7721307","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4745.0,"discounted_cash":1898.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Hfx Size 8 36Mm Offst 140Mm Cement Primary Reconstruct Cocr 132Deg Angle 30Mm","code_information":[{"code":"7721308","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13648.0,"discounted_cash":5459.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 30Mm 2Lvl Ti Extra Lordot Ant Cervical 171.280","code_information":[{"code":"7721309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Snare Endo Electrosurgical Snaremaster 0.3Mm Wire 230Cm 25Mm Upper Lower Gi Crescent Loop Thin","code_information":[{"code":"7721310","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Aspen 12Mm Lck Construct","code_information":[{"code":"7721311","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Aspen 10Mm Lck Construct","code_information":[{"code":"7721312","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Aspen Wide 10Mm Compo Std Ti Post Body","code_information":[{"code":"7721313","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15504.0,"discounted_cash":6201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Aspen 8Mm Lck Construct","code_information":[{"code":"7721314","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Aspen 14Mm Lck Construct","code_information":[{"code":"7721315","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Continental Med 35X15X24Mm Peek Ant Lumb 15Deg Lordot","code_information":[{"code":"7721316","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dvr 21.6X48.9Mm 4-Hole Short Narrow Timax Anatomic Lt Dist Volar Radial Fast Guide Ns","code_information":[{"code":"7721317","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2534.0,"discounted_cash":1013.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 103Mm 8-Hole Lck Timax Bilat Fibula Composite Ns","code_information":[{"code":"7721318","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gauge Depth K-Wire Sm 6In F/Fragment System","code_information":[{"code":"7721319","type":"CDM"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":281.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 164Mm 12-Hole Lck Timax Bilat Fibula Composite Ns","code_information":[{"code":"7721320","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Hernia C-Qur 12.5X12.5                          31544","code_information":[{"code":"7721321","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":557.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Eds Whisper 190Cm    4647","code_information":[{"code":"7721322","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Acuity Whisper View Hi-Torque Extra Support 0.014Inx190Cm Coronary Sinus J-Tip Dist","code_information":[{"code":"7721323","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Ds Whisper 190Cm     4636","code_information":[{"code":"7721324","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Std Long 175Mm Prox Periarticular Tibial Strt Cannul Jacobs Chuck End Ss F/3.5/2.7Mm","code_information":[{"code":"7721325","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":391.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.7X14Mm Non-Cannulated Lck Self-Tap Partial Thread Cortic Biodur 108 Alloy Elbow F/Small","code_information":[{"code":"7721326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X14Mm Non-Cannulated Lck Partial Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721327","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X12Mm Non-Cannulated Lck Partial Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X20Mm Non-Cannulated Lck Partial Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X16Mm Non-Cannulated Lck Partial Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X22Mm Non-Cannulated Lck Partial Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721331","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 106Mm 6-Hole Pre-Contoured Lck Ss Fixed Angle Lt Lat Dist Fibula Periarticular","code_information":[{"code":"7721332","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2440.0,"discounted_cash":976.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 1.6Mm 6In Partial Thread Trocar Tip Smooth Shaft F/Cannulated Screw System","code_information":[{"code":"7721333","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho F/3.5/4Mm Screw","code_information":[{"code":"7721334","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.7Mm Cannul Qck-Conn F/3Mm Screw Fixat","code_information":[{"code":"7721335","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1558.0,"discounted_cash":623.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X50Mm Cannul 1/2 25Mm Thread Self-Drilling/Tapping Biodur 108 Alloy Hex Cruciform Drive","code_information":[{"code":"7721336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 28Mm 2Lvl Ti Extra Lordot Ant Cervical 171.278","code_information":[{"code":"7721337","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 32Mm 2Lvl Ti Extra Lordot Ant Cervical 171.282","code_information":[{"code":"7721338","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 15Mm 1Lvl Ti Extra Lordot Ant Cervical 171.165","code_information":[{"code":"7721339","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":2115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Long Acutrak2 At2-Ml1813 Acutrak 2 Long Drill","code_information":[{"code":"7721340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Mini 3.5-3.6X22Mm Cannul Compress Headless Full Wide Thread Strl","code_information":[{"code":"7721341","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":690.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Mini 3.5-3.6X16Mm Cannul Compress Headless Full Wide Thread","code_information":[{"code":"7721342","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":690.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Mini 3.5-3.6X18Mm Cannul Compress Headless Full Wide Thread","code_information":[{"code":"7721343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":690.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Vip 13Mm 1Lvl Ti Extra Lordot Ant Cervical 171.163","code_information":[{"code":"7721344","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":2115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Fr 7X60Mm 135Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721345","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5905.0,"discounted_cash":2362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X60Mm Full Thread Self-Tap Cancell Ss Periarticular Ns","code_information":[{"code":"7721346","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3.5Mm Long 195Mm Qck-Conn Ss","code_information":[{"code":"7721347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Biological Tissue Xenform 6X10Cm Fetal Bovine Dermal Matrix Frz-Dry Pelvic Floor","code_information":[{"code":"7721348","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3670.0,"discounted_cash":1468.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Biological Tissue Xenform 8X12Cm Fetal Bovine Dermal Matrix Frz-Dry Pelvic Floor","code_information":[{"code":"7721349","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5007.0,"discounted_cash":2002.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Capio Slim #0 36In 1/2 Circ Dbl-Arm Tapercut M0068332351 Monofil Pp W/Needle Nonabsorbable","code_information":[{"code":"7721350","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im T2 10Mm Std 300Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7721351","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5361.0,"discounted_cash":2144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Ncb 4.3X300Mm Dist Femur Quick-Coupling Ss Ns","code_information":[{"code":"7721352","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Ncb 246Mm 9-Hole Lck Ti Protasul-64 Non-Cont Bridge Polyaxial Lt Dist Periprosthetic","code_information":[{"code":"7721353","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5404.0,"discounted_cash":2161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 5X85Mm Non-Cannulated Non-Locking 32Mm Partial Thread Polyaxial Self-Tap Cancell","code_information":[{"code":"7721354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 5X50Mm Non-Cannulated Non-Locking 32Mm Partial Thread Polyaxial Self-Tap Cancell","code_information":[{"code":"7721355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 5X80Mm Non-Cannulated Non-Locking 32Mm Partial Thread Polyaxial Self-Tap Cancell","code_information":[{"code":"7721356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X60Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7721357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X40Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7721358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X36Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7721359","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X48Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7721360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X85Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7721361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X38Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7721362","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X80Mm Non-Locking Partial Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7721363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X50Mm Non-Locking Full Thread Self-Tap Solid Cortic Ti F/Small Frag Plate","code_information":[{"code":"7721364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X46Mm Non-Locking Full Thread Self-Tap Solid Cortic Ti F/Small Frag Plate","code_information":[{"code":"7721365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 4.5X36Mm Non-Locking Full Thread Self-Tap Solid Cortic Ti F/Small Frag Plate","code_information":[{"code":"7721366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peri Strips 60     C-Slra-Sc60","code_information":[{"code":"7721367","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":273.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Syringe Inject Stellant D 60In 200Ml T-Shaped Dual Low-Pressure Tube Quick Fill Lf F/Ct System","code_information":[{"code":"7721368","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Triathlon Size 4 22Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7721370","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5714.0,"discounted_cash":2285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 5 Resurfac Primary Revis Cocr Lt Medial Rt Lat","code_information":[{"code":"7721371","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4643.0,"discounted_cash":1857.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 6 Resurfac Unicompart Primary Cocr Lt Medial Rt Lat","code_information":[{"code":"7721372","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7848.0,"discounted_cash":3139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 8Mm Lt Medial Rt Lat Artic Surface X3 F/Partial Knee Resurfac Strl","code_information":[{"code":"7721373","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3038.0,"discounted_cash":1215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trident Size D 48Mm Cluster-Hole Hemis Primary Modul Lck Solid Back Tritanium Hap","code_information":[{"code":"7721374","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5448.0,"discounted_cash":2179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hip Compo Peak Fx 100X135Mm Lag Assembly Ns","code_information":[{"code":"7721375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X360Mm 130Deg Angle Cannul Lck Antegrad Lt Femur Trochan Ti Alloy Lime","code_information":[{"code":"7721376","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7392.0,"discounted_cash":2956.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Mmx6Frx100Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7401.0,"discounted_cash":2960.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 125Deg F/Hip Inter Fixat System","code_information":[{"code":"7721378","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Intrauterine Bakri 24Frx54Cm 500Ml Bln W/60Ml Syringe Dual Check Vlv 180Cm Iv Tubing Bag","code_information":[{"code":"7721379","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Hip Compo Peak Fx 110X135Mm Lag Assembly Ns","code_information":[{"code":"7721380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.0,"discounted_cash":572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Hfx Size 7 35Mm Offst 130Mm Cement Primary Reconstruct Cocr 132Deg Angle 30Mm","code_information":[{"code":"7721381","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13648.0,"discounted_cash":5459.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size D 32Mm 46-48Mm 10Deg Angle Primary Crossfire Strl","code_information":[{"code":"7721382","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4654.0,"discounted_cash":1861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Sm 11X14X9Mm Peek 5Deg Lordot","code_information":[{"code":"7721383","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4566.0,"discounted_cash":1826.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 2X150Mm Kirschner Temp 15Mm Thread Plain Trocar Tip Ss Ns F/Small Frag System","code_information":[{"code":"7721384","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":40.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat Combo Adjust Mandibular Ti","code_information":[{"code":"7721385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":557.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 2.5X4X14Mm Thread Self-Drill Mandibular Ti F/Fixator 2 Body Ns","code_information":[{"code":"7721386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 2.5X4X10Mm Thread Self-Drill Mandibular Ti F/Fixator 2 Ns","code_information":[{"code":"7721387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":441.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat 4Mm Pre-Bent Conn Mandibular Ramus Ti Ns","code_information":[{"code":"7721388","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2168.0,"discounted_cash":867.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cap Protect Ns F/4Mm Carbon Fiber Rod/Tube","code_information":[{"code":"7721389","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 2.5X4X18Mm Thread Self-Drill Mandibular Ti F/Fixator 2 Body Ns","code_information":[{"code":"7721390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":441.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 8 115Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7721391","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15077.0,"discounted_cash":6030.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Size 14 180Mm Cementls Collar Ti Arc Hap Plasma Spray 132Deg Angle Hip","code_information":[{"code":"7721392","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13648.0,"discounted_cash":5459.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 142Mm 6-Hole Pre-Contoured Compress Lck Ss Rt Dist Medial Tibial F/3.5Mm Screw W/O","code_information":[{"code":"7721393","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":2162.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gold Reload Staple      Gst60D","code_information":[{"code":"7721394","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak 2 3.2Mm Std Long 32Mm Cervical Qr Ss Ns F/Headless Compress Screw","code_information":[{"code":"7721395","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 30Mm Strl","code_information":[{"code":"7721396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":690.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 26/12Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721397","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":31445.0,"discounted_cash":12578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Stent Con 1W11412C105Xh","code_information":[{"code":"7721398","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15772.0,"discounted_cash":6308.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Stent Iliac 1Xw1212C81Xh","code_information":[{"code":"7721399","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13304.0,"discounted_cash":5321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 26/14Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721400","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29685.0,"discounted_cash":11874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Stent Iliac 1Xw1414C80Xh","code_information":[{"code":"7721401","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13304.0,"discounted_cash":5321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Stent Iliac 1Exch151555","code_information":[{"code":"7721402","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8458.0,"discounted_cash":3383.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Prolite 4X5In Plug Pp Nonabsorbable Knit Self-Forming Ventral Pre-Shaped","code_information":[{"code":"7721403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Prolite Std 15X15Cm Pp Nonabsorbable Knit Trim Medwt Round Edge Inguinal Square Flat Sheet","code_information":[{"code":"7721404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Parietene 15X10Cm Monofil Pp Macroporous Inguinal Flat Sheet F/Hernia Repair","code_information":[{"code":"7721405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 24/12Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721406","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29685.0,"discounted_cash":11874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Generator Dual Chamber    5826 Zephyr Xl Dr Pacemaker","code_information":[{"code":"7721407","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":23641.0,"discounted_cash":9456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Hernia C-Qur 10X15  31528","code_information":[{"code":"7721408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.0,"discounted_cash":477.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Laryngoscope Glidescope Gvl Stat Size 3 78Mm 21X36Mm/16X16Mm Camera Sm Adult Flange Ti Lf Strl","code_information":[{"code":"7721409","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Laryngoscope Glidescope Gvl Stat Size 4 92Mm 28X54Mm/20X15Mm Camera Adult Flange Ti Lf Strl","code_information":[{"code":"7721410","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Stent Vascular/Biliary Lifestent 6Mmx6Frx60Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5817.0,"discounted_cash":2326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Dvr 24.4X54.3Mm 3-Hole Short Timax Anatomic Std Lt Dist Volar Radial W/Fast Guide","code_information":[{"code":"7721412","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2534.0,"discounted_cash":1013.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bur E9000 Rnd 6.5X38  E8165Lso 10 Flute","code_information":[{"code":"7721413","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X36Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7721414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":312.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 77Mm 3-Hole Pre-Contoured Lck Ss Fixed Angle Lt Prox Ulnar Ns","code_information":[{"code":"7721415","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2842.0,"discounted_cash":1136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X40Mm Non-Cannulated Lck Full Thread Self-Tap Ss Conical Periarticular Elbow","code_information":[{"code":"7721416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X18Mm Non-Cannulated Lck Partial Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X34Mm Non-Cannulated Lck Self-Tap Fixed Angle Cortic Ss Periarticular Elbow W/2.7Mm","code_information":[{"code":"7721418","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X30Mm Non-Cannulated Lck Self-Tap Fixed Angle Cortic Ss Periarticular Elbow W/2.7Mm","code_information":[{"code":"7721419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Zps 2X150Mm Kirschner Temp Smooth Single-Ended Plain Trocar Point Ss Ns F/Small Frag","code_information":[{"code":"7721420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":85.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blocker Spinal Xia 3 Set Screw Close Ti Buttress Ns","code_information":[{"code":"7721421","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1161.0,"discounted_cash":464.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Mantis 6X120Mm Curve Hex Ti Thoracolum Malleab Min Radius Ns Laser Etch","code_information":[{"code":"7721422","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2244.0,"discounted_cash":897.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Xia Ii 6.5X45Mm Open Polyaxial Cort/Canc Pedicle Ti 60Deg Gray 50Deg Angle Top","code_information":[{"code":"7721423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 14X8X12Mm 7Deg Lordot","code_information":[{"code":"7721424","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14447.0,"discounted_cash":5778.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coalition 3.6X12Mm Self-Drill Var Ang Ti Ns","code_information":[{"code":"7721425","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1941.0,"discounted_cash":776.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Stent Vascular/Biliary Lifestent 6Mmx6Frx150Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8813.0,"discounted_cash":3525.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 194Mm 10-Hole Pre-Contoured Compress Lck Ss Lt Dist Medial Tibial F/3.5Mm Screw W/O","code_information":[{"code":"7721427","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5517.0,"discounted_cash":2206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 1.044X1.577In 50Deg Angle 360Deg Total Rotat Intermed Rod-Rod Cartridge Jet-X","code_information":[{"code":"7721428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2137.0,"discounted_cash":854.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat Traction 7Mm Long 50Mm 375Mm Non-Threaded Ankle Foot Jet-X Ss Ti Nitride Strl","code_information":[{"code":"7721429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 10Mmx34Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gold Strl","code_information":[{"code":"7721430","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6696.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Fr 7X40Mm 135Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5817.0,"discounted_cash":2326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X80Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X25Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721433","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Bladeless Optical 8X100Mm Z-Threaded Sleeve Port Abdomin Access","code_information":[{"code":"7721434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":251.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Voice Rapid Response 16Frx8Mm Esoph Indwell F/Tep Proc Blom-Singer Classic Strl","code_information":[{"code":"7721435","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8507","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Voice Rapid Response 16Frx10Mm Esoph Indwell F/Tep Proc Blom-Singer Classic Strl","code_information":[{"code":"7721436","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8509","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Voice Rapid Response 16Frx12Mm Esoph Indwell F/Tep Proc Blom-Singer Classic Strl","code_information":[{"code":"7721437","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8509","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Voice Rapid Response 20Frx6Mm Silver Oxide Indwell Hard Vlv Blom-Singer Advantage","code_information":[{"code":"7721438","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Voice Rapid Response 20Frx8Mm Silver Oxide Indwell Hard Vlv Blom-Singer Advantage","code_information":[{"code":"7721439","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Prosthesis Voice Rapid Response 20Frx10Mm Silver Oxide Indwell Hard Vlv Blom-Singer Advantage","code_information":[{"code":"7721440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":990.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Arthro Mini Tightrope Lo-Pro W/2.7Mm Cannul Drill Bit 5.5Mm Round/2.6Mm Oblong Button 1.6Mm","code_information":[{"code":"7721441","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2384.0,"discounted_cash":953.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X30Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X32Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 77Mm 6-Hole Compress Lck Timax Dist Fibula Composite Ns","code_information":[{"code":"7721444","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X22Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X24Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721446","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X26Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721447","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 6-Hole Contour Lck Timax Lt Dist Medial Tibial F/3.5Mm Screw Ns","code_information":[{"code":"7721448","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4540.0,"discounted_cash":1816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X20Mm Lck Thread Self-Tap Multi-Direct Cortic Cocr 15Deg Angle Cone Square","code_information":[{"code":"7721449","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":218.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 5-Hole Lck Ti 1St Tarsometatarsal Ns","code_information":[{"code":"7721450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3863.0,"discounted_cash":1545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 14X7X12Mm 7Deg Lordot","code_information":[{"code":"7721451","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14447.0,"discounted_cash":5778.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tack Ortho Forefoot/Midfoot Lck F/Plate Fixat Ns Pl-Tack","code_information":[{"code":"7721452","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X24Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7721453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Non Locking      C0-3300 3.5 X 30 Mm Non Locking Screw","code_information":[{"code":"7721454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 2.5X150Mm Kirschner Temp 15Mm Thread Plain Trocar Tip Ss Ns F/Small Frag System","code_information":[{"code":"7721455","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 2.5X4X8Mm Thread Self-Drill Mandibular Ti F/Fixator 2 Ns","code_information":[{"code":"7721456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.0,"discounted_cash":441.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 13Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7721457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 2 Cementls C/R Bead Rt","code_information":[{"code":"7721458","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9473.0,"discounted_cash":3789.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 2 16Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7721459","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 6-Hole Sm Contour Lck Timax Rt Medial Dist Tibial F/3.5Mm Screw Ns","code_information":[{"code":"7721460","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4540.0,"discounted_cash":1816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X50Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X32Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721462","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X40Mm Lck Thread Self-Tap Multi-Direct Cortic Cocr 15Deg Angle Cone Square","code_information":[{"code":"7721463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":218.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Tornado 5/3Mm P/D Taper 4.1Cm Pushable Sm End Existing Synthetic Fiber Platin","code_information":[{"code":"7721464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Spinal Revere 6/7.5X40Mm Lck Polyaxial Dual Outer Diameter Cort/Canc Pedicle Ti Top Load","code_information":[{"code":"7721465","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3351.0,"discounted_cash":1340.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coagulator Electrosurgical Valleylab Suction Cautery Monopol 8Frx2.67Mm 6In Shaft Ent Hand Switch","code_information":[{"code":"7721466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Spinal Vip 4.6X16Mm Self-Drill Var Ang Ti Ant Cervical","code_information":[{"code":"7721467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.0,"discounted_cash":354.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 6 10Mm Half Block Revis Total Stabil Ti Lt Medial Rt Lat Strl","code_information":[{"code":"7721468","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 7 Univ Cement Stabil Revis Cocr Lt Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7721469","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7631.0,"discounted_cash":3052.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 7 10Mm Half Block Revis Total Stabil Ti Lt Medial Rt Lat Strl","code_information":[{"code":"7721470","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 7 Cement Post Stabil Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7721471","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9752.0,"discounted_cash":3900.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Triathlon Kinemax Plus 25X80Mm Revis Total Stabil Flute Cocr Knee Strl","code_information":[{"code":"7721472","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2875.0,"discounted_cash":1150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Triathlon 12X50Mm Cement Total Stabil Cocr Knee W/Endcap Strl","code_information":[{"code":"7721473","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3142.0,"discounted_cash":1256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Fr 7X80Mm 135Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5994.0,"discounted_cash":2397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 7Mmx6Frx100Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7401.0,"discounted_cash":2960.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Xia 3 Radius 6X90Mm Non-Hexagonal Non-Threaded Ti Pedicle Thoracolum Ns Laser Etch","code_information":[{"code":"7721476","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2324.0,"discounted_cash":929.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Airway Laryngeal Lma Unique Mask Size 1 Cuffed Aperture Bar Pilot Silicone Pvc Tube Lf Strl Disp","code_information":[{"code":"7721477","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Airway Laryngeal Lma Unique Mask Size 1.5 Infant Cuffed Aperture Bar Pilot Silicone Pvc Tube Lf","code_information":[{"code":"7721478","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Airway Laryngeal Lma Unique Mask Size 2 Infant Child Cuffed Aperture Bar Pilot Silicone Pvc Tube Lf","code_information":[{"code":"7721479","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Airway Laryngeal Lma Unique Mask Size 2.5 Child Cuffed Aperture Bar Pilot Silicone Pvc Tube Lf","code_information":[{"code":"7721480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Nexgen Legacy Size G 70.5/76.5Mm Cement Post Stabil Zimaloy Non-Porous Rt Lat Strl","code_information":[{"code":"7721481","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11687.0,"discounted_cash":4674.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Overtube Endo Guardus 16.7X19.5Mm Std 25Cm Taper Tip 2-Tube Insufflat Cap W/8.6-10Mm Scope Intro","code_information":[{"code":"7721482","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 5X70Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7721483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":226.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 6 Cement Primary Bead Cocr Peri-Apatite Knee","code_information":[{"code":"7721484","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4486.0,"discounted_cash":1794.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 16Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7721485","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5349.0,"discounted_cash":2139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Gore Bio-A 9X15Cm 67% Pga 33% Tmc 300-Hold Reinforc Abdomin Wall Flat Sheet","code_information":[{"code":"7721486","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":918.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Cornerstone Psr Verte-Stack 14X11X7Mm Strut Anatomic Peek Ant Cervical","code_information":[{"code":"7721487","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5272.0,"discounted_cash":2108.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary Valeo 7Mmx6Frx56Mm 80Cm Otw Bln-Expand Mount Ss 0.035In Gw","code_information":[{"code":"7721488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4587.0,"discounted_cash":1834.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Cornerstone Psr Verte-Stack 11X14X7Mm Strut Anatomic Peek Ant Cervical","code_information":[{"code":"7721489","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary Valeo 10Mmx7Frx26Mm 80Cm Otw Bln-Expand Mount Ss 0.035In Gw","code_information":[{"code":"7721490","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4587.0,"discounted_cash":1834.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary E-Luminexx 7Mmx6Frx40Mm 80Cm Otw Slf-Expand Flared End Nitinol W/Safe Delivery System","code_information":[{"code":"7721491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary E-Luminexx 7Mmx6Frx60Mm 80Cm Otw Slf-Expand Flared End Nitinol W/Safe Delivery System","code_information":[{"code":"7721492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary E-Luminexx 8Mmx6Frx40Mm 80Cm Otw Slf-Expand Flared End Nitinol W/Safe Delivery System","code_information":[{"code":"7721493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary E-Luminexx 6Fr 8X60Mm 80Cm Otw Slf-Expand Flared End Nitinol W/Safe Delivery System","code_information":[{"code":"7721494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary E-Luminexx 8Mmx6Frx80Mm 80Cm Otw Slf-Expand Flared End Nitinol W/Safe Delivery System","code_information":[{"code":"7721495","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Biliary E-Luminexx 10Mmx6Frx40Mm 80Cm Otw Slf-Expand Flared End Nitinol W/Safe Delivery System","code_information":[{"code":"7721496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Restoration 21Mm Revis Modul Bolt Ti Hap Porous Conical +20Mm Neck Prox Hip","code_information":[{"code":"7721497","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12887.0,"discounted_cash":5154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Restoration 16X155Mm Revis Modul Ti Plasma Spray Strt Conical Dist Hip","code_information":[{"code":"7721498","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9240.0,"discounted_cash":3696.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur V40 40Mm +4Mm Offst Taper Primary Modul Anatomic Low Friction Ion Treatment Cocr Hip Strl","code_information":[{"code":"7721499","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4665.0,"discounted_cash":1866.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Ultrapro Large      Uppl2","code_information":[{"code":"7721500","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Ultrapro 3X6         Umr3","code_information":[{"code":"7721501","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 13.6Cm 4.2Cm Mod Plus-Profile 450Ml Silicone Gel Smooth Ant","code_information":[{"code":"7721502","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3173.0,"discounted_cash":1269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 14.6Cm 4.5Cm Mod Plus-Profile 550Ml Silicone Gel Smooth Ant","code_information":[{"code":"7721503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3173.0,"discounted_cash":1269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Trigen 3.2Mm Short Humeral 2-Flute Grad S N Brad Pt","code_information":[{"code":"7721505","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":356.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4X24Mm Lck Self-Tap Cortic Ti Hex Head Light Blue Dist Humeral","code_information":[{"code":"7721506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 5X36Mm Lck Self-Tap Cancell Ti Hex Head Green Prox Humeral","code_information":[{"code":"7721507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":295.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 5X30Mm Lck Self-Tap Cancell Ti Hex Head Green Prox Humeral","code_information":[{"code":"7721508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":295.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10/8.5Mm Long 240Mm Bend Cannul Antegrade/Retrograde Multi-Planar Humeral Ti Alloy","code_information":[{"code":"7721509","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5976.0,"discounted_cash":2390.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4X20Mm Lck Self-Tap Cortic Ti Hex Head Light Blue Dist Humeral","code_information":[{"code":"7721510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4X26Mm Lck Self-Tap Cortic Ti Hex Head Light Blue Dist Humeral","code_information":[{"code":"7721511","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Silk Perma-Hand #0 18In 1/2 Circ Ct-1 Control Release Taper Point Pop Off Black 8 Strands/Pk","code_information":[{"code":"7721512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture 3-0 Vicryl Ct1  Vcp838D","code_information":[{"code":"7721513","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Agent Hemostat Microfibrillar Collagen Absorb Avitene Powder Flowable","code_information":[{"code":"7721514","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":173.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Countersink Drill Disp F/Cortical/Cancellous Screw","code_information":[{"code":"7721515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X40Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7721516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X46Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7721517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":200.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X48Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7721518","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":200.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Ultrapro Small      Upps2","code_information":[{"code":"7721519","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Ultrapro Medium     Uppm2","code_information":[{"code":"7721520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":421.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Gore Bio-A 7X10Cm 1Mm 67% Polygly Acid 33% Trimethy Carbo Tube Reinforc Soft Tissue Flat","code_information":[{"code":"7721521","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1679.0,"discounted_cash":671.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trident Size E 40Mm 50-52Mm 3.8Mm 0Deg Angle Primary X3 Strl","code_information":[{"code":"7721522","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4654.0,"discounted_cash":1861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Biliary E-Luminexx 10Mmx6Frx80Mm 80Cm Otw Slf-Expand Flared End Nitinol W/Safe Delivery System","code_information":[{"code":"7721523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Occlus Delivery 6Frx90Cm Periph 2Lumen F/Lead Vns Cat B Wg Press","code_information":[{"code":"7721524","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Ncb 4X38Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7721525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 12.5Cm 3.9Cm Mod Plus-Profile 350Ml Silicone Gel Smooth Ant","code_information":[{"code":"7721526","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3173.0,"discounted_cash":1269.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Flexor Sheath Guiding 8Frx45Cm Ansel Modif Mp Tip Check-Flo Hemostat Vlv","code_information":[{"code":"7721528","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Countersink Drill 6.5Mm","code_information":[{"code":"7721529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 6Mm F/2346-66 Screw","code_information":[{"code":"7721530","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5X40Mm 16Mm Partial Thread Cancell Ss Periarticular Ns","code_information":[{"code":"7721531","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Ncb 172Mm 3/7-Hole Lck Ti Non-Cont Bridge Lt Lat Prox Tibial F/Universal System Ns","code_information":[{"code":"7721532","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5284.0,"discounted_cash":2113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X65Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7721533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Rapidsorb 6X82Mm 20-Hole 0.8Mm Scallop Strt Polymer Rapid Resorb Adaption F/1.5Mm Screw","code_information":[{"code":"7721534","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Rapidsorb 1.5X4Mm Cortic Polymer Rapid Resorb Cmf Strl","code_information":[{"code":"7721535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Rapidsorb 1.5X6Mm Cortic Polymer Rapid Resorb Cmf Strl","code_information":[{"code":"7721536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Rapidsorb 35X35Mm 0.5Mm Polymer Rapid Resorb Clear F/1.5Mm Screw Orbital Floor Strl","code_information":[{"code":"7721537","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":1024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Template Bending 8-Hole F/1.5Mm Resorb Cranfac Adaption Plate","code_information":[{"code":"7721538","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Med 34X13X26Mm 15Deg Lordot","code_information":[{"code":"7721539","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":38139.0,"discounted_cash":15255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Independence 5.5X30Mm Var Ang Ti Ant Cervical","code_information":[{"code":"7721540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":1024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Admiral Xtreme Dilat 8X60Mm 130Cm Otw 2Lumen Coaxial F/Pta 6-Fold Lo-Pro","code_information":[{"code":"7721541","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/24Mm P/D 90Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721542","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14535.0,"discounted_cash":5814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 28/18Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721543","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30918.0,"discounted_cash":12367.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Coronary 28/28X29Mm 20Fr Cath Aorta","code_information":[{"code":"7721544","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10135.0,"discounted_cash":4054.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Fr 7X70Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721545","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10398.0,"discounted_cash":4159.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 14-Hole Compress Lck Timax Lo-Pro Anatomic Hybrid Foot F/3.5Mm Screw Ns","code_information":[{"code":"7721546","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X26Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X34Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X26Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X24Mm Lck Thread Self-Tap Multi-Direct Cortic Cocr 15Deg Angle Cone Square","code_information":[{"code":"7721550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":218.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X26Mm Lck Thread Self-Tap Multi-Direct Cortic Cocr 15Deg Angle Cone Square","code_information":[{"code":"7721551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":218.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Axis Tutoplast 8X12Cm Non-Freeze-Dried Process Gamma Irrad Dermis Pericardium","code_information":[{"code":"7721552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":4056.0,"discounted_cash":1622.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Wholey 0.035Inx175Cm Shapeable Strt Tip Fixed Core Support Soft Std Steer Microglide","code_information":[{"code":"7721553","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Knife Endo Fusion Needle Access 6Fr Tip 7Frx200Cmx4Mm Cut Wire Bile Duct Adjust Purple Strl Disp","code_information":[{"code":"7721554","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":255.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Mini 4-Hole Curve Broad Lck Ti F/2Mm Screw Mandibular Ns","code_information":[{"code":"7721555","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":519.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Biopsy Temno 18Ga 6Cm 20Mm Sample Notch Semi-Automated Soft Tissue Bevel Sharp Tip Echo Cm","code_information":[{"code":"7721556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Device Inflat Relieva Stratus Endo Spacer Frontal Sinus Microflow F/Catheter Lf Strl Disp","code_information":[{"code":"7721557","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3367.0,"discounted_cash":1346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 6.5Mmx7.7In Ss Qck-Conn","code_information":[{"code":"7721558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5X60Mm 16Mm Partial Thread Cancell Ss Periarticular Ns","code_information":[{"code":"7721559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5X65Mm 16Mm Partial Thread Cancell Ss Periarticular Ns","code_information":[{"code":"7721560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb 4X90Mm Non-Cannulated Non-Locking Polyaxial Self-Tap Bicortical Protasul-64 Hex Head","code_information":[{"code":"7721561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Mini 4-Hole Broad Lck Ti F/2Mm Screw Mandibular Ns","code_information":[{"code":"7721562","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1518.0,"discounted_cash":607.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 9-Hole Lck","code_information":[{"code":"7721563","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3863.0,"discounted_cash":1545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Surgibit Twist 2.8Mm Long 6.25In Qr Ns F/Congruent Elbow System","code_information":[{"code":"7721564","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X20Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder Ns","code_information":[{"code":"7721565","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X24Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7721566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X26Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7721567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.4X12Mm Cruciform Recess Cortic Ti Full Thread Self-Tap Gold F/Modular Mini Frag System","code_information":[{"code":"7721568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Drill Twist 2.4Mm Maxillofacial Ns F/Universal Trocar System","code_information":[{"code":"7721569","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 5 16Mm Artic Surface Post Stabil Bearing Uhmwpe Strl","code_information":[{"code":"7721570","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":1711.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Mini 3.5-3.6X28Mm Cannul Compress Headless Full Wide Thread","code_information":[{"code":"7721571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":690.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak 2 2.7Mm Mini Long 32Mm Cervical Qr Compress Ss Ns F/3.5-4Mm Headless Screw","code_information":[{"code":"7721572","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Viperwire Advance 0.014In Tip 335Cm Periph","code_information":[{"code":"7721573","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":224.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7721574","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":113.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Acutrak 2 2Mm Micro Mini Cervical Qr Profile Compress Ss Ns F/3.5-4Mm Headless Screw - D","code_information":[{"code":"7721575","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sling Gyn Monarc Hammock Subfascial","code_information":[{"code":"7721576","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":3863.0,"discounted_cash":1545.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Fr 7X150Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8813.0,"discounted_cash":3525.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg Hi-Line Xs Size 3 2.35Mm Side Cut Tc Strl Disp","code_information":[{"code":"7721578","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 7Mmx8Cm 135Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7721579","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 10Mmx36Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gold Strl","code_information":[{"code":"7721580","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6727.0,"discounted_cash":2690.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Global Fx 8X130Mm Eccentric Modul Cocr Porous","code_information":[{"code":"7721581","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13743.0,"discounted_cash":5497.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Global Advantage 44X21Mm Cocr","code_information":[{"code":"7721582","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6593.0,"discounted_cash":2637.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 95Mm 3-Hole Pre-Contoured Lck Timax Rt Dist Fibula System Ns","code_information":[{"code":"7721583","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Nester 10Mmx14Cm Pushable 4.5-Loop Synthetic Fiber Platin Mri-Cond 0.035In Cath","code_information":[{"code":"7721584","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coil Emboliz Mreye 4Mmx3Cm High Radial Force Pushable 2.4-Loop Inconel Synthetic Fiber Mri-Cond","code_information":[{"code":"7721585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coil Emboliz Mreye 5Mmx5Cm High Radial Force Pushable 3.1-Loop Inconel Synthetic Fiber Mri-Cond","code_information":[{"code":"7721586","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coil Emboliz Mreye 8Mmx5Cm High Radial Force Pushable 2-Loop Inconel Synthetic Fiber Mri-Cond","code_information":[{"code":"7721587","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Tornado 7/3Mm P/D 8Cm Pushable Sm End Existing Synthetic Fiber Platin Mri-Cond","code_information":[{"code":"7721588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Tornado 6/2Mm P/D Taper 7Cm Pushable Sm End Existing Synthetic Fiber Platin","code_information":[{"code":"7721589","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Tornado 8/4Mm P/D 9.5Cm Pushable Sm End Existing Synthetic Fiber Platin Mri-Cond","code_information":[{"code":"7721590","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Cd Horizon Legacy 6.5X40Mm Multiaxial Pedicle Ti Top Loading/Tightening F/5.5Mm Rod","code_information":[{"code":"7721591","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5651.0,"discounted_cash":2260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Screw Spinal Cd Horizon Legacy 5.5X20Mm Revers Angle Break Off Ti Pedicle Hex","code_information":[{"code":"7721592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Capstone 12X26Mm Tantalum Marker Peek Vertebral Transforaminal Post Lumb 0Deg Angle","code_information":[{"code":"7721593","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19605.0,"discounted_cash":7842.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Nanocross Elite Dilatat 2/1.5X210Mm 150Cm Otw Semi-Compli F/Pta Ultra","code_information":[{"code":"7721594","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1962.0,"discounted_cash":784.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 7X40Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721595","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 8X40Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721596","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 7X100Mm 135Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7721597","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 8X80Mm 135Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721598","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 10X60Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721599","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 9X60Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7721600","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 26/14Mm P/D 170Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721601","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30387.0,"discounted_cash":12154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/16Mm P/D 75Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721602","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12599.0,"discounted_cash":5039.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Dart-Fire 1.1Mmx3In Kirschner Temp Smooth Plain Trocar Point","code_information":[{"code":"7721603","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Charlotte Sm Ss Fusion Rt Mtp","code_information":[{"code":"7721604","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4532.0,"discounted_cash":1812.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Mtp Hex 2.7X14  41122714","code_information":[{"code":"7721605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trap Spec Retriev Etrap Endo Device Magnified Window Remov Strainer W/2-Tray F/Polypectomy Lf Disp","code_information":[{"code":"7721606","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Hps 2X12Mm Cannul Lag Headed Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 2X14Mm Cannul Lag Headed Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 4X22Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X26X10Mm Self-Distract Peek Ti Thoracolum Oblique","code_information":[{"code":"7721613","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X10Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X26X11Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7721616","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Mmx6Frx80Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":2115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Mmx6Frx40Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721618","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5112.0,"discounted_cash":2044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Lifestent 6Mmx6Frx170Mm 130Cm Otw Slf-Expand Nitinol Superficial Femur","code_information":[{"code":"7721619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":9515.0,"discounted_cash":3806.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 56Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7721620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5525.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Asphere 40Mm +5Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7721621","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12686.0,"discounted_cash":5074.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 7 42X155Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721622","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13790.0,"discounted_cash":5516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Introducer Cath Classicsheath 9.5Fr Std 13Cm Split Hemostat Vlv Robust W/J-Tip Gw Dil 18Ga Ndl","code_information":[{"code":"7721625","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X26X8Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7721626","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15152.0,"discounted_cash":6060.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X55Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7721627","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3383.0,"discounted_cash":1353.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 4 Cement Constrain Revis Oxinium Lt Knee","code_information":[{"code":"7721628","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17442.0,"discounted_cash":6976.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 14X120Mm Cementls Strt Revis Slot Primary Press-Fit Bilat Std Leg Ti Knee","code_information":[{"code":"7721629","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3562.0,"discounted_cash":1424.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupler Femur Legion +2Mm Stemmed Angle Offst Metal Back Knee","code_information":[{"code":"7721630","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1465.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 4 Cement Stemmed Taper Revis Ti Porous Lt Knee Strl","code_information":[{"code":"7721631","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7631.0,"discounted_cash":3052.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Femur Legion Size 3-4 Long Std Univ 5Mm Revis Post Knee W/Screw On","code_information":[{"code":"7721632","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3269.0,"discounted_cash":1307.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 3-4 68-71Mm/48-50Mm 18Mm Lt Rt Artic Surface Constrain Xlpe Strl","code_information":[{"code":"7721633","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5548.0,"discounted_cash":2219.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 15X160Mm Cementls Strt Revis Slot Press-Fit Primary Bilat Std Leg Ti Knee","code_information":[{"code":"7721634","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3566.0,"discounted_cash":1426.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Saw Genesis Ii Oscillat 1.27Mm Narrow F/Hall Power Pro Knee System","code_information":[{"code":"7721635","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Saw Genesis Ii Oscillat 1.27Mm Wide F/Hall Power Pro Knee System","code_information":[{"code":"7721636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Ultrabraid #2 38In Shoulder Preload Needled 7210915 Arthro Co-Braid Uhmwpe Nonabsorbable Strl","code_information":[{"code":"7721637","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":40.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Pinnacle 54Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7721638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5525.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 36X54Mm +4 Neutral Altrx","code_information":[{"code":"7721639","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5560.0,"discounted_cash":2224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 6 42X150Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721640","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13790.0,"discounted_cash":5516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 6 Cement Post Stabil Oxinium Lt Knee","code_information":[{"code":"7721641","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1756.0,"discounted_cash":702.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 6 77/54Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Lt Knee","code_information":[{"code":"7721642","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9260.0,"discounted_cash":3704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 70-74Mm/52-54Mm 9Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7721643","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6277.0,"discounted_cash":2510.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Instrument Ortho 3.2Mm Pin Drill Genesis","code_information":[{"code":"7721644","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":262.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 15Mm Short 8.5Mm Strt Woven Iliac Ext Cuff","code_information":[{"code":"7721645","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9732.0,"discounted_cash":3892.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 52Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7721646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5261.0,"discounted_cash":2104.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 36X52Mm +4 Neutral Altrx","code_information":[{"code":"7721647","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5292.0,"discounted_cash":2116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Summit Size 4 48X140Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721648","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13133.0,"discounted_cash":5253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 36Mm +1.5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7721649","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8291.0,"discounted_cash":3316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 7 Cement Post Stabil Oxinium Rt Knee","code_information":[{"code":"7721650","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18790.0,"discounted_cash":7516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 6 77/54Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Rt Knee","code_information":[{"code":"7721651","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8820.0,"discounted_cash":3528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 74-77Mm/52-54Mm 11Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7721652","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5979.0,"discounted_cash":2391.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Revere 5.5X40Mm Lck Polyaxial Thread Dbl Lead Pedicle Ti Post Thoracolum Top Load","code_information":[{"code":"7721653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":1277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 14X9X12Mm 7Deg Lordot","code_information":[{"code":"7721654","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13759.0,"discounted_cash":5503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 16X8X14Mm 7Deg Lordot","code_information":[{"code":"7721655","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13759.0,"discounted_cash":5503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coalition 3.6X14Mm Self-Drill Var Ang Ti Ns","code_information":[{"code":"7721656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1941.0,"discounted_cash":776.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im T2 12Mm Std 375Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7721657","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Overtube Endo Guardus 16.7X19.5Mmx50Cm Taper Tip 2-Tube Insufflat Cap W/9.8-11.7Mm Scope Intro","code_information":[{"code":"7721658","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wallflex Stent Cove 10X60 7053","code_information":[{"code":"7721659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9482.0,"discounted_cash":3792.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Kypho Pak      Kpt1505-Cds","code_information":[{"code":"7721660","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":13503.0,"discounted_cash":5401.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Platelet Concentrat Process Autologous-120 F/Harvesting Smartprep 20Ml","code_information":[{"code":"7721661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":996.0,"discounted_cash":398.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Platelet Concentrat Process F/Smart Prep System 14-20Ml Prp","code_information":[{"code":"7721662","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2587.0,"discounted_cash":1034.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wand Arthro Procise Lw Plasma","code_information":[{"code":"7721663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":488.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 8.5Mmx33Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gray Strl","code_information":[{"code":"7721664","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6379.0,"discounted_cash":2551.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Sling Gyn Uphold Polyform Synthetic Mesh Assembly Intra-Vaginal Ant Sacrospinous W/1-Capio","code_information":[{"code":"7721665","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5485.0,"discounted_cash":2194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 26X12X12Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7721666","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14432.0,"discounted_cash":5772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak Plus Dense Bone Cannul","code_information":[{"code":"7721667","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":862.0,"discounted_cash":344.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Ball Tip","code_information":[{"code":"7721668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":303.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shaft Reamer Bixcut","code_information":[{"code":"7721669","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X60Mm Neutral Altrx","code_information":[{"code":"7721670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4813.0,"discounted_cash":1925.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Summit Size 7 44X155Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721671","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13133.0,"discounted_cash":5253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 36Mm +5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7721672","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8291.0,"discounted_cash":3316.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trocar Endo Endopath Xcel Bladeless Optical 5X75Mm Lo-Pro Thread Stability Sleeve Stopck W/Seal Vlv","code_information":[{"code":"7721673","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Endo Endopath Xcel Shield Bladed Univ 5X75Mm Lo-Pro Thread Stability Stopck W/Seal Vlv","code_information":[{"code":"7721674","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Genesis 1/8In 5In Trocar Tip Ss F/Centering Point Compass","code_information":[{"code":"7721675","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Saw Amsco Hall Reciprocat Dbl-Side","code_information":[{"code":"7721676","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Saw Genesis Ii Reciprocat 1Mm Sgl Side F/Hall Power Pro Knee System","code_information":[{"code":"7721677","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Journey Deuce Size 5 Cement Unicompart Lt Medial Rt Lat","code_information":[{"code":"7721678","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6144.0,"discounted_cash":2457.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Journey Size 5 Unicompart Fixed Bearing Oxinium Lt Medial Rt Lat","code_information":[{"code":"7721679","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15053.0,"discounted_cash":6021.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Journey Size 5-6 8Mm Lt Medial Rt Lat Artic Surface Unicompart Pe","code_information":[{"code":"7721680","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3159.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 3 38X135Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721681","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13133.0,"discounted_cash":5253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 104Mm 6-Hole Pre-Contoured Lck Ss Fixed Angle Rt Prox Lat Tibial F/2.7/3.5Mm Screw","code_information":[{"code":"7721682","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4093.0,"discounted_cash":1637.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 6.5 75Mm      2347-26-75 6.5 75 Mm Cancellous Screw","code_information":[{"code":"7721683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X80Mm Cannul Lck Full Thread Self-Tap Cortic Ss Conical Periarticular","code_information":[{"code":"7721684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X60Mm Cannul Lck Full Thread Self-Tap Cortic Ss Conical Periarticular","code_information":[{"code":"7721685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X70Mm Cannul Lck Full Thread Self-Tap Cortic Ss Periarticular F/Universal","code_information":[{"code":"7721686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X85Mm Cannul Lck Full Thread Self-Tap Cortic Ss Conical Periarticular Elbow","code_information":[{"code":"7721687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X38Mm Non-Cannulated Lck Full Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Motionloc 3.5X36Mm Non-Cannulated Lck Full Thread Self-Tap Cortic Ss Conical","code_information":[{"code":"7721689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Size 2 8Mm Unicompart Pe Lt Medial Rt Lat","code_information":[{"code":"7721690","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5994.0,"discounted_cash":2397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Gh/7-10 14Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7721691","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6199.0,"discounted_cash":2479.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade 54Mm Explant  7053-54-20 Long Explant 54 Mm Blade","code_information":[{"code":"7721692","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade 54 Mm Explant 7053-54-10 Short Explant 54 Mm Blade","code_information":[{"code":"7721693","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3527.0,"discounted_cash":1410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Prostalac Size 3 200Mm Cement Revis Std Offst Cocr 135Deg Angle Rt Hip","code_information":[{"code":"7721694","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15116.0,"discounted_cash":6046.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Prostalac 32X42Mm Cement Revis Pe","code_information":[{"code":"7721695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1675.0,"discounted_cash":670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +1Mm Neck 12/14 Taper Modul Cocr Hip","code_information":[{"code":"7721696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2953.0,"discounted_cash":1181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Osteotome Surg Moreland Blade 10Mm Thin 1.5In Knee U-Shaped Flex F/Cementless Revis","code_information":[{"code":"7721697","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Moreland Blade 10Mm Thin 3In Knee U-Shaped Flex F/Cementless Revis","code_information":[{"code":"7721698","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Moreland Blade 12Mmx8In Knee U-Shaped F/Cementless Revis","code_information":[{"code":"7721699","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":278.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Moreland Blade 10Mm Plat 6In Knee U-Shaped Thin F/Cementless Revis","code_information":[{"code":"7721700","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Cement Post Stabil Oxinium Rt Knee","code_information":[{"code":"7721701","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18796.0,"discounted_cash":7518.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 5 74/52Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Rt Knee","code_information":[{"code":"7721702","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8820.0,"discounted_cash":3528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 1.6Mm Long 150Mm Kirschner Temp Smooth Sharp/Blunt Trocar Tip F/Hallu-Fix","code_information":[{"code":"7721703","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 2.5Mm Long 200Mm Kirschner Temp Blunt Tip F/Advansys Hind Foot Plate","code_information":[{"code":"7721704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":71.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trial Trauma Implant 7-Hole Plate Tibiotalocalcaneal","code_information":[{"code":"7721705","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Meche 3X190Mm Ao Disp F/4.5Mm Screw Advansys Hindfoot Plate","code_information":[{"code":"7721706","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Meche 3.5X200Mm Ao Disp F/6.5Mm Screw Advansys Hindfoot Plate","code_information":[{"code":"7721707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho 6.5Mm Lck Ss F/Surfix Strl","code_information":[{"code":"7721708","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho 4.5Mm Lck Ss F/Surfix Strl","code_information":[{"code":"7721709","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Surfix 4.5X30Mm Lck Replace Ss Hindfoot F/Advansys Plate Strl","code_information":[{"code":"7721710","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Surfix 4.5X45Mm Lck Replace Ss Hindfoot F/Advansys Plate Strl","code_information":[{"code":"7721711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Surfix 4.5X40Mm Lck Replace Ss Hindfoot F/Advansys Plate Strl","code_information":[{"code":"7721712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Paste Bone Graft Trel Xc 3Ml Revers Phase Med Cancell Dbm Poloxamer","code_information":[{"code":"7721713","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1731.0,"discounted_cash":692.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Surfix 4.5X35Mm Lck Replace Ss Hindfoot F/Advansys Plate Strl","code_information":[{"code":"7721714","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":364.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Surfix 6.5X35Mm Lck Replace Ss Hindfoot F/Advansys Plate Strl","code_information":[{"code":"7721715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Advansys Ttc 43.7X130.6Mm 7-Hole Ss Lt Tibiotalocalcaneal Strl","code_information":[{"code":"7721716","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3975.0,"discounted_cash":1590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Surfix 6.5X30Mm Lck Replace Ss Hindfoot F/Advansys Plate Strl","code_information":[{"code":"7721717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wallflex Stent 10X8  M00570540","code_information":[{"code":"7721718","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9482.0,"discounted_cash":3792.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 32X52Mm +4 Neutral Altrx","code_information":[{"code":"7721719","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4296.0,"discounted_cash":1718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 4 40X140Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721720","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13133.0,"discounted_cash":5253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +1Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7721721","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4996.0,"discounted_cash":1998.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 32X48Mm +4 Neutral Altrx","code_information":[{"code":"7721722","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4296.0,"discounted_cash":1718.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 48Mm No-Hole Primary Gription 100 Series","code_information":[{"code":"7721723","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11948.0,"discounted_cash":4779.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 3 44X135Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721724","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13133.0,"discounted_cash":5253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +5Mm Neck 12/14 Taper Modul Cocr Hip","code_information":[{"code":"7721725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2190.0,"discounted_cash":876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tray Kyphoplasty Kyphopak 1St Frx W/Size 3 20Mm 2-Kyphon Xpander Ibt 1-Step Osteo Intro 2-Inflation","code_information":[{"code":"7721726","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":13601.0,"discounted_cash":5440.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur G7 32Mm +12Mm Neck Compo Type 1 Taper Modul Non-Skirted Dual Mobility Construct Cocr Hip","code_information":[{"code":"7721727","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2431.0,"discounted_cash":972.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 3 Cement Post Stabil Oxinium Lt Knee","code_information":[{"code":"7721728","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18790.0,"discounted_cash":7516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 3-4 68-71Mm/48-50Mm 9Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7721729","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5979.0,"discounted_cash":2391.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Genesis Ii 32Mm 9Mm 3-Peg Resurfac Post Retain Anatomic Uhmwpe","code_information":[{"code":"7721730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3615.0,"discounted_cash":1446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Trilogy 6.5X15Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cortic Strl","code_information":[{"code":"7721731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular 58Mm Multi-Hole Hemis Primary Revis Modul Solid Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7721732","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10980.0,"discounted_cash":4392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Acetabular 54Mm Strt Buttress Revis Trabecul Metal W/Spacer Strl","code_information":[{"code":"7721733","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10179.0,"discounted_cash":4071.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Hgp Ii 6.5X25Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cancell Strl","code_information":[{"code":"7721734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Hgp Ii 6.5X20Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cancell Strl","code_information":[{"code":"7721735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Hgp Ii 6.5X15Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cancell Strl","code_information":[{"code":"7721736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":221.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 32X58X7Mm Offst 7.3Mm Full Hemis Primary Modul Longevity Xl Uhmwpe Strl","code_information":[{"code":"7721737","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5847.0,"discounted_cash":2338.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Pha S1 6.5X45Mm Ti Extend Tab","code_information":[{"code":"7721738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3024.0,"discounted_cash":1209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Spinal Malibu Lck 1Lvl","code_information":[{"code":"7721739","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Sonoma 5.5X40Mm Pre-Contoured 3Lvl Ti Lck Split Ring","code_information":[{"code":"7721740","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Hollywood 11X27X11Mm Peek Transforaminal Lumb Lordot F/Interbody Fusion Ns","code_information":[{"code":"7721741","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13422.0,"discounted_cash":5368.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe Nerve Stimulator Increment Std Prass Tip Strl Individ Pk","code_information":[{"code":"7721742","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Et Nim Contact Emg 7X10.5Mm Oral Nasal Cuffed Reinforc W/Smooth Conduct Ink Electrode Green","code_information":[{"code":"7721743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":341.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Et Nim Contact Emg 6X9Mm Oral Nasal Cuffed Reinforc W/Smooth Conduct Ink Electrode Green White","code_information":[{"code":"7721744","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":341.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Et Nim Trivantage Emg 8X9.5Mm Std Oral Nasal Cuffed Non-Reinforced W/Smooth Conduct Ink","code_information":[{"code":"7721745","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":341.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Emg 12Mm Subdermal Lancet Tip 2-Pin Four-Channel Sharp Paired W/Twisted Wire Green White","code_information":[{"code":"7721746","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Electrode Emg 12Mm Subdermal Ground Lancet Tip 2-Pin 2-Chann Sharp Paired W/Twisted Wire Green White","code_information":[{"code":"7721747","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stent Icast 10X38        85424","code_information":[{"code":"7721748","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":8210.0,"discounted_cash":3284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur S-Rom 11Mm/16Mm D/P Long 205Mm Cementls Revis Std Ti 11/13 Taper 36Mm Neck Rt Hip","code_information":[{"code":"7721749","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11440.0,"discounted_cash":4576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur S-Rom 28Mm +6Mm Neck 11/13 Taper Modul M-Specification Cocr","code_information":[{"code":"7721750","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2589.0,"discounted_cash":1035.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur S-Rom Ztt Size 16B Lg Cementls Conical Modul Porous Prox Hip","code_information":[{"code":"7721751","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4963.0,"discounted_cash":1985.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 60Mm No-Hole Primary Gription 100 Series","code_information":[{"code":"7721752","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11948.0,"discounted_cash":4779.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 40X60Mm +4 Neutral Altrx","code_information":[{"code":"7721753","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10780.0,"discounted_cash":4312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 40Mm +1.5Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7721754","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12565.0,"discounted_cash":5026.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 5 40X145Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721755","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13133.0,"discounted_cash":5253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Nexgen Med 50Mm Conical Revis Trabecul Metal Tivanium Rt Dist Knee","code_information":[{"code":"7721756","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17036.0,"discounted_cash":6814.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Gmrs Kinemax Plus Press-Fit 15Mm Reg 155Mm Cementls Revis Modul Flute Rotat Hinge Ti","code_information":[{"code":"7721757","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3025.0,"discounted_cash":1210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Augment Duracon 10Mm Lck Bi-Thallium Dist Femur","code_information":[{"code":"7721758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":101.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Augment Duracon 5Mm Lck Bi-Thallium Dist Femur","code_information":[{"code":"7721759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":101.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Duracon Med Lg 5Mm Wedge/Block Spacer Revis Thallium Non-Porous Rt Medial Dist Knee","code_information":[{"code":"7721760","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2388.0,"discounted_cash":955.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Duracon Med Lg Total Stabil Revis Rt","code_information":[{"code":"7721761","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14120.0,"discounted_cash":5648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur Gmrs Kinemax Plus 4Mm Offst Cementls Revis Modul Flute Rotat Hinge Dist Hip W/Jam Nut","code_information":[{"code":"7721762","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2899.0,"discounted_cash":1159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Duracon Med Lg 10Mm Wedge/Block Spacer Revis Thallium Non-Porous Rt Lat Dist Knee","code_information":[{"code":"7721763","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2388.0,"discounted_cash":955.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Duracon Med 13Mm Lt Rt Post Stabil Lipped","code_information":[{"code":"7721764","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shuttlecock Cath Short  G48151 4.5Fr X 75Cm","code_information":[{"code":"7721765","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys Size 14 135Mm Cementls Low Demand/Fracture Zimaloy 12/14 Taper Press-Fit Hip Strl","code_information":[{"code":"7721766","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6421.0,"discounted_cash":2568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 43Mm Unipol 12/14 Taper Primary Endoprosthesis Zimaloy Hip Strl","code_information":[{"code":"7721767","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1898.0,"discounted_cash":759.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Journey Size 3-4 9Mm Rt Medial Lt Lat Artic Surface Unicompart Pe","code_information":[{"code":"7721768","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":782.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Journey Deuce Size 4 Cement Unicompart Rt Medial Lt Lat","code_information":[{"code":"7721769","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3806.0,"discounted_cash":1522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Journey Size 3 Unicompart Fixed Bearing Oxinium Rt Medial Lt Lat","code_information":[{"code":"7721770","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9318.0,"discounted_cash":3727.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Journey Size 4 Unicompart Fixed Bearing Oxinium Lt Medial Rt Lat","code_information":[{"code":"7721771","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9318.0,"discounted_cash":3727.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Journey Deuce Size 3 Cement Unicompart Lt Medial Rt Lat","code_information":[{"code":"7721772","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3806.0,"discounted_cash":1522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Journey Size 3-4 11Mm Lt Medial Rt Lat Artic Surface Unicompart Pe","code_information":[{"code":"7721773","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":782.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X18Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 8 52X160Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721775","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12509.0,"discounted_cash":5003.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Trufuse","code_information":[{"code":"7721776","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14061.0,"discounted_cash":5624.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Trufuse 5Mm Dowel Dual","code_information":[{"code":"7721777","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14061.0,"discounted_cash":5624.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 4 Cement Post Stabil Oxinium Rt Knee","code_information":[{"code":"7721778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16542.0,"discounted_cash":6616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 7 Cement Post Stabil Oxinium Lt Knee","code_information":[{"code":"7721779","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17544.0,"discounted_cash":7017.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 7-8 81-85Mm/56-59Mm 9Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7721780","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 13-Hole Lck Ti Olecranon","code_information":[{"code":"7721781","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3504.0,"discounted_cash":1401.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone W/3.5Mm Screw Tap Ns","code_information":[{"code":"7721782","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":328.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X20Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7721783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 4X40Mm Cancell Ti Hex Head Ns","code_information":[{"code":"7721784","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 4X50Mm Cancell Ti Hex Head Ns","code_information":[{"code":"7721785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 26/12Mm P/D 170Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7721786","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29157.0,"discounted_cash":11662.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/12Mm P/D 105Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7721787","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14302.0,"discounted_cash":5720.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Hemodialysis Power-Trialysis Acute 13Fr 15Cm 3Lumen Strt Tip Power Inject W/0.035In Gw","code_information":[{"code":"7721788","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Pinnacle 66Mm Multi-Hole Bantam Primary Gription W/6.5Mm Dome Screw","code_information":[{"code":"7721789","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7669.0,"discounted_cash":3067.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X66Mm +4 Neutral Altrx","code_information":[{"code":"7721790","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5040.0,"discounted_cash":2016.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Polyax 179.4Mm 6-Hole Lck Timax Rt Dist Femur Ns","code_information":[{"code":"7721791","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4204.0,"discounted_cash":1681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guiderod Ortho G-Force Tensioner 8Mm Tendon W/Suture Loop F/Intraoperative","code_information":[{"code":"7721792","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference G-Force 6X15Mm Peek-Optima Thread Pull-Out F/Tenodesis Soft Tissue","code_information":[{"code":"7721793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1745.0,"discounted_cash":698.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X22Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reamer Surg G-Force 6Mm Forefoot Cannul","code_information":[{"code":"7721795","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":309.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Size 2 Cement Unicompart High Flexion Tivanium Lt Medial Rt Lat","code_information":[{"code":"7721796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6683.0,"discounted_cash":2673.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Zuk Size 2 8Mm Net-Shaped Artic Surface Unicompart High Flexion Mold Uhmwpe Strl","code_information":[{"code":"7721797","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2819.0,"discounted_cash":1127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Dextrus Perm Bipol 6.7Frx60Cm 10Mm Space Rt Atrial Ventric Helical Tip Steroid Elut","code_information":[{"code":"7721798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3200.0,"discounted_cash":1280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 52Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7721799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6725.0,"discounted_cash":2690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Pinnacle 64Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7721800","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5011.0,"discounted_cash":2004.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle Ultamet Xl 44X64Mm Neutral Cocr Metal","code_information":[{"code":"7721801","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14432.0,"discounted_cash":5772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 44Mm +8.5Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7721802","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12880.0,"discounted_cash":5152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 16Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7721803","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5402.0,"discounted_cash":2160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Hip Cement Omnifit 14Mm Univ Centralizer Dist Femur Strl","code_information":[{"code":"7721804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Storq Workhorse 0.035Inx180Cm Modif J-Tip Soft Steer Ss Ptfe Slx W/Torque Device","code_information":[{"code":"7721805","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Atherectomy Turbohawk Lxc 3.5-7Mmx113Cm Extend Calcium Tip Smooth Super Cutter Lg Vessel Ss","code_information":[{"code":"7721806","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9910.0,"discounted_cash":3964.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Intertan 11.5Mm Short 380Mm 125Deg Angle Cannul Interlocking Antegrad Rt Intertrochan","code_information":[{"code":"7721807","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6587.0,"discounted_cash":2634.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Trigen Meta-Nail Pilot 4Mm Short 161Mm Ao Connect Strl Disp","code_information":[{"code":"7721808","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Screw Bone Trigen Intertan 7/11X95/100Mm Compress Lag Interlocking Integrate Ti","code_information":[{"code":"7721809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":918.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Legion Size 6 Cement Post Stabil Oxinium Rt Knee","code_information":[{"code":"7721810","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16542.0,"discounted_cash":6616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Femoral Component     71421214 Sz 4 Left Posterior Oxinium","code_information":[{"code":"7721811","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11520.0,"discounted_cash":4608.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X26X11Mm Self-Distract Peek Ti Thoracolum Oblique","code_information":[{"code":"7721812","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13743.0,"discounted_cash":5497.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 54Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7721813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6843.0,"discounted_cash":2737.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Solution System 15Mmx8In Cementls Lg Stature Cocr Porocoat 12/14 Taper Strt","code_information":[{"code":"7721814","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17685.0,"discounted_cash":7074.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +12Mm Neck 12/14 Taper Modul Total Stabil Biolox Delta Ts Hip","code_information":[{"code":"7721815","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9789.0,"discounted_cash":3915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Parietex 8.6Cm 1.7Mm Optimiz Composite Patch Pes Porcine Collagen Film Absorb Knit Trim","code_information":[{"code":"7721816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.0,"discounted_cash":733.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mesh Surg Parietex 6.6Cm 1.7Mm Optimiz Composite Patch Pes Porcine Collagen Film Absorb Knit Trim","code_information":[{"code":"7721817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1486.0,"discounted_cash":594.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Mesh Hernia C-Qur 9X9    31543","code_information":[{"code":"7721818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":314.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 2X120Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7721819","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2321.0,"discounted_cash":928.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 8Mm Rt Medial Lt Lat Artic Surface X3 F/Partial Knee Resurfac Strl","code_information":[{"code":"7721820","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2864.0,"discounted_cash":1145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 6 Resurfac Primary Revis Cocr Rt Medial Lt Lat","code_information":[{"code":"7721821","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4377.0,"discounted_cash":1750.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Resurfac Unicompart Primary Cocr Rt Medial Lt Lat","code_information":[{"code":"7721822","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7401.0,"discounted_cash":2960.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys 12X125Mm Primary Extend Offst Tivanium Porous Fiber Metal 12/14 Taper Strt Lg","code_information":[{"code":"7721823","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18570.0,"discounted_cash":7428.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 46Mm Unipol 12/14 Taper Primary Endoprosthesis Zimaloy Hip Strl","code_information":[{"code":"7721824","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1898.0,"discounted_cash":759.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur Versys +7Mm Neck Unipol Head 12/14 Taper Endoprosthesis Non-Porous Ti Hip Strl","code_information":[{"code":"7721825","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless 5X75Mm Short Adv Fixat Sleeve W/Obturator Abdomin","code_information":[{"code":"7721826","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 9-Hole Contour Lck Timax Lt Dist Tibial Medial F/3.5Mm Screw Ns","code_information":[{"code":"7721827","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X20Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X24Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X28Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7721830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X46Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7721831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X30Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X34Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7721833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Cable-Ready 187Mm 6-Hole Ss F/4.5Mm Screw Ns","code_information":[{"code":"7721834","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2304.0,"discounted_cash":921.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cable Ortho Cable-Ready 1.8Mmx24In Cocr Greater Trochan F/Bone Plate","code_information":[{"code":"7721835","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X34Mm Full Thread Self-Tap Cortic Ss Periarticular Ns","code_information":[{"code":"7721836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X36Mm Full Thread Self-Tap Cortic Ss Periarticular Ns","code_information":[{"code":"7721837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 3 Cement Post Stabil Oxinium Rt Knee","code_information":[{"code":"7721838","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16542.0,"discounted_cash":6616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 3 64/48Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Rt Knee","code_information":[{"code":"7721839","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8056.0,"discounted_cash":3222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 3-4 68-71Mm/48-50Mm 11Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7721840","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 40Mm +5Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7721842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10299.0,"discounted_cash":4119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Versanail 9Mm Univ 240Mm Cannul Lck Humeral Ti Alloy Strl","code_information":[{"code":"7721843","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4503.0,"discounted_cash":1801.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Versanail 3.2Mm Short 14In Thread Femur Tibial Humeral Ns","code_information":[{"code":"7721844","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":59.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 4 Cement Post Stabil Oxinium Lt Knee","code_information":[{"code":"7721845","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16542.0,"discounted_cash":6616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 3-4 68-71Mm/48-50Mm 13Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7721846","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pump Penile Ams 700 Lgx 12Mmx18Cm Saline-Filled Inflate Pre-Connected Infrapubic Cylindr","code_information":[{"code":"7721847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":22047.0,"discounted_cash":8818.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Applier Clip 10Mm        Ca090","code_information":[{"code":"7721848","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Bag Spec Retriev Inzii Lap Device 10Mm Port Std 225Ml Cap Cylindr Guide Bead Extra Wide Open","code_information":[{"code":"7721849","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Bone Medpor 20Mm Sphere Pe Biocompat Reconstruct Porous Trim F/Oculoplastic Surg Orbital","code_information":[{"code":"7721850","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1666.0,"discounted_cash":666.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X125Mm Strt Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7721851","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 31Mm 3-Hole Sm Curve Lck Ti Std Midshaft Volar Radial Head Ns","code_information":[{"code":"7721852","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3504.0,"discounted_cash":1401.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.3X24Mm Lck Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist Hand","code_information":[{"code":"7721853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 2.3X26Mm Lck Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist Hand","code_information":[{"code":"7721854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 2.3X18Mm Non-Locking Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist","code_information":[{"code":"7721855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Surgibit 2Mm Clavicle Qr Coupl Calib","code_information":[{"code":"7721856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Endcap Ortho Trigen 6.4Mm 20Mm Ext Ti F/Intramedullary Nail","code_information":[{"code":"7721857","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":303.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cement Bone Smartset Gmv 40Gm Med Viscos Pmma Gentamicin Lf Strl 14Min Setting Time","code_information":[{"code":"7721858","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":358.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Size 5 10Mm Net Shape Artic Surface Unicompart High Flexion Mold Uhmwpe Strl","code_information":[{"code":"7721859","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2819.0,"discounted_cash":1127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Size 5 Cement Unicompart High Flexion Tivanium Lt Medial Rt Lat","code_information":[{"code":"7721860","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6683.0,"discounted_cash":2673.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im T2 12Mm Std 420Mm Cannul Lck Dist Tibial Ti Alloy Strl","code_information":[{"code":"7721861","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5200.0,"discounted_cash":2080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guiderod Ortho Trigen Intertan 3Mm 600Mm Ball Tip Im","code_information":[{"code":"7721862","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 11.5X200Mm Cannul Lck Antegrade/Retrograde Rt Hindfoot Humeral Ti Alloy Fusion Rose","code_information":[{"code":"7721863","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9616.0,"discounted_cash":3846.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X90Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7721864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel Long 20Mmx5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel Long 12Mmx5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Long 10Mmx5In Ss Hip Thin","code_information":[{"code":"7721867","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Chisel Short 20Mmx2.5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721868","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Short 12Mmx3In Ss Hip Thin","code_information":[{"code":"7721869","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel Short 12Mmx2.5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721870","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Osteotome Surg Size 3 Short 10Mm Ss Hip Thin","code_information":[{"code":"7721871","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Osteotome Surg Short 8Mmx3In Ss Hip Thin Lf","code_information":[{"code":"7721872","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":215.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 11Mmx8In Ss","code_information":[{"code":"7721873","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":564.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 11.5Mmx8In Ss","code_information":[{"code":"7721874","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 12Mmx8In Ss","code_information":[{"code":"7721875","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 12.5Mm Long 8In Ss","code_information":[{"code":"7721876","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 13Mm Long 8In Ss","code_information":[{"code":"7721877","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg C-Stem Amt 13.5X203Mm Ss","code_information":[{"code":"7721878","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 14Mmx8In Ss","code_information":[{"code":"7721879","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 14.5Mm Long 8In Ss","code_information":[{"code":"7721880","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 15Mm Long 8In Ss","code_information":[{"code":"7721881","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 15.5Mmx8In Ss","code_information":[{"code":"7721882","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 16Mmx8In Ss","code_information":[{"code":"7721883","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 16.5Mmx8In Ss","code_information":[{"code":"7721884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 17Mmx8In Ss Disp","code_information":[{"code":"7721885","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 17.5Mmx8In Ss","code_information":[{"code":"7721886","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 18Mmx8In Ss","code_information":[{"code":"7721887","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 18.5Mmx8In Ss","code_information":[{"code":"7721888","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 19Mmx8In Ss","code_information":[{"code":"7721889","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 19.5Mmx8In Ss","code_information":[{"code":"7721890","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 20Mmx8In Ss","code_information":[{"code":"7721891","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 20.5Mmx8In Ss","code_information":[{"code":"7721892","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 21Mmx8In Ss","code_information":[{"code":"7721893","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 21.5Mmx8In Ss","code_information":[{"code":"7721894","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 22Mmx8In Ss","code_information":[{"code":"7721895","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 22.5Mmx8In Ss","code_information":[{"code":"7721896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 23Mmx8In Ss","code_information":[{"code":"7721897","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 23.5Mmx8In Ss","code_information":[{"code":"7721898","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Trephine Surg 24Mmx8In Ss","code_information":[{"code":"7721899","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Thin 12Mm Ss Hip Curve Blade","code_information":[{"code":"7721900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Blade 20Mm Ss Hip Curve Thin","code_information":[{"code":"7721901","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Blade 20Mmx3In Ss Hip Thin","code_information":[{"code":"7721902","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg Blade 8Mmx5In Ss Hip Thin","code_information":[{"code":"7721903","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg 10Mmx5In Ss Hip Radial","code_information":[{"code":"7721904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Osteotome Surg 12Mmx5In Ss Hip Radial","code_information":[{"code":"7721905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Osteotome Surg 14Mmx5In Ss Hip Radial","code_information":[{"code":"7721906","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg 16Mmx6In Ss Hip Radial","code_information":[{"code":"7721907","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Osteotome Surg 20Mmx5In Ss Hip Radial","code_information":[{"code":"7721908","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Chisel 8Mmx5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721909","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel 8Mmx2.5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721910","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel 10Mmx2.5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721911","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Chisel 10Mmx5In Osteotome Flex Hip Ss Lf","code_information":[{"code":"7721912","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Catheter Atherectomy Turbohawk Lxc 8Frx110Cm 50Cm Std Calcium Tip Direct High Efficiency","code_information":[{"code":"7721913","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9910.0,"discounted_cash":3964.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 40X58Mm +4 Neutral Altrx","code_information":[{"code":"7721914","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10267.0,"discounted_cash":4106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 40Mm +1.5Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7721915","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10299.0,"discounted_cash":4119.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Endo Visiglide 0.025Inx270Cm 70Mm Stiff Flex Strt Tip F/Ercp Fluorine Hydrphil Disp","code_information":[{"code":"7721916","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Cable-Ready 246Mm 8-Hole Ss F/4.5Mm Screw Ns","code_information":[{"code":"7721917","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2809.0,"discounted_cash":1123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cable Ortho Cable-Ready 1.8Mmx36In Cerclage Ss Strl","code_information":[{"code":"7721918","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X34Mm Cannul Lag Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7721919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Triathlon Size 8 5Mm Total Stabil Cocr Rt Dist Knee Strl","code_information":[{"code":"7721920","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3343.0,"discounted_cash":1337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Triathlon Size 8 10Mm Total Stabil Cocr Post Knee Strl","code_information":[{"code":"7721921","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3507.0,"discounted_cash":1402.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 8 Cement Total Stabil Revis Tritanium Cocr Rt Strl","code_information":[{"code":"7721922","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17262.0,"discounted_cash":6904.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Triathlon 23X100Mm Cementls Revis Total Stabil Press-Fit Flute Ti Knee W/Trial Cut","code_information":[{"code":"7721923","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3319.0,"discounted_cash":1327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 22Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7721924","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6367.0,"discounted_cash":2546.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 Std 19Mm Artic Surface Total Stabil Plus Flexion X3 Strl","code_information":[{"code":"7721925","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6718.0,"discounted_cash":2687.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 7 5Mm Half Block Revis Total Stabil Ti Rt Medial Lt Lat Strl","code_information":[{"code":"7721926","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2909.0,"discounted_cash":1163.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 7 5Mm Half Block Revis Total Stabil Ti Lt Medial Rt Lat Strl","code_information":[{"code":"7721927","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2909.0,"discounted_cash":1163.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Cpr Impedance Threshold Non-Invas Circulatory Enhancer W/2-Timing Light Resqpod Itd 10","code_information":[{"code":"7721928","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Cable-Ready 305Mm 10-Hole Ss F/4.5Mm Screw Strl","code_information":[{"code":"7721929","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3442.0,"discounted_cash":1376.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Actifuse Abx 1-2Mm Paste 5Ml Moldable Sculptable Tcp Silicon Hap Calcium Oxide","code_information":[{"code":"7721930","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3678.0,"discounted_cash":1471.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Joint Instrument 3Mm Tibial Achievecas","code_information":[{"code":"7721932","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Block Cut Dist Femur Visionaire F/Legion Primary","code_information":[{"code":"7721933","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Block Cut Prox Tibial Visionaire F/Legion Primary","code_information":[{"code":"7721934","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 6 Cement C/R Primary Revis Oxinium Rt","code_information":[{"code":"7721935","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11018.0,"discounted_cash":4407.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 74-77Mm/52-54Mm 9Mm Lt Rt Artic Surface C/R Xlpe Strl","code_information":[{"code":"7721936","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3701.0,"discounted_cash":1480.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Marker Radiology Margin Breast","code_information":[{"code":"7721937","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Spinal Aspen 16Mm Lck Construct","code_information":[{"code":"7721938","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Aspen 18Mm Lck Construct","code_information":[{"code":"7721939","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 2 64/45Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Lt Knee","code_information":[{"code":"7721940","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular 52Mm Multi-Hole Hemis Primary Revis Modul Solid Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7721941","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10455.0,"discounted_cash":4182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 36X3.5Mm Offst Longevity","code_information":[{"code":"7721942","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5286.0,"discounted_cash":2114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 1-2 60-64Mm/42-45Mm 9Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7721943","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5262.0,"discounted_cash":2104.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 36Mm +3.5Mm Neck 12/14 Taper Primary Endoprosthesis Cocr Hip Strl","code_information":[{"code":"7721944","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3085.0,"discounted_cash":1234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X85Mm Strt Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7721945","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Transition 6.5X40Mm Polyaxial Pedicle Hap Post Tlso Top Load Softstop Strl","code_information":[{"code":"7721946","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4705.0,"discounted_cash":1882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 8X27Mm 80Cmx30Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7721947","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3200.0,"discounted_cash":1280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 8X37Mm 135Cmx40Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7721948","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3200.0,"discounted_cash":1280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 2 38X130Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7721949","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12509.0,"discounted_cash":5003.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +8.5Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7721950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5021.0,"discounted_cash":2008.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tube Ventilation 2.7Mm Flange 1.14Mm Lumen 1Mm Ifd Bobbin Ti Ear Blue Strl","code_information":[{"code":"7721951","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Sustain 10X26X8Mm Self-Distract Peek Ti Thoracolum Oblique","code_information":[{"code":"7721952","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13743.0,"discounted_cash":5497.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Transition 7.5X35Mm Polyaxial Pedicle Hap Post Tlso Top Load Softstop Strl","code_information":[{"code":"7721953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4705.0,"discounted_cash":1882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Osteotome Surg 7Mmx17In X-Shaped","code_information":[{"code":"7721954","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1591.0,"discounted_cash":636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Global Fx 10X120Mm Eccentric Modul Cocr Porous","code_information":[{"code":"7721955","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13337.0,"discounted_cash":5334.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Global Advantage 44X18Mm Cocr","code_information":[{"code":"7721956","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6339.0,"discounted_cash":2535.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Corkscrew 3.5X12Mm Thread Nonabsorbable Eyelet Inserter W/2-#0 Fiberwire 1/2 Circ","code_information":[{"code":"7721957","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 47Mm Unipol Modul Cathcart Ball Orthocentric Hip F/Fracture","code_information":[{"code":"7721958","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":429.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 54Mm Unipol Modul Cathcart Ball Orthocentric Hip F/Fracture","code_information":[{"code":"7721959","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":429.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Quill           Ra-1069","code_information":[{"code":"7721960","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":68.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X16Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7721961","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 4X18Mm Cannul Lck Full Thread Asif Ss Hex Recess Ns","code_information":[{"code":"7721962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X30Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7721963","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 7.3X85Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Cortic Ss","code_information":[{"code":"7721964","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.0,"discounted_cash":408.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 242Mm 10-Hole Pre-Contoured Compress Lck Ss Lt Condylar Femur F/4.5Mm Screw Ns","code_information":[{"code":"7721965","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5595.0,"discounted_cash":2238.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 2.5Mm 300Mm 12Mm Thread Drill Tip Cocr Ns","code_information":[{"code":"7721966","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":99.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Manipulator Uterine Elevator Pro Cup 35Mm Med Cervical W/Occluder Bln Lf Strl","code_information":[{"code":"7721967","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw 3.5Mm X 25.0Mm Hco3250-S Polarus Humeral Cortical Scre","code_information":[{"code":"7721968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.8Mm Short Polarus","code_information":[{"code":"7721969","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Polarus Hand 3.5Mm Tip Humeral Witness Hole Maker Lf Ns F/Rod System","code_information":[{"code":"7721970","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Short Explant 7053-52-10 52 Mm Short Explant Blade","code_information":[{"code":"7721971","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Long Explant  7053-52-20 52 Mm Long Explant Blade","code_information":[{"code":"7721972","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size G 70.5/76.5Mm Cement Post Stabil Zimaloy Non-Porous Lt Lat Strl","code_information":[{"code":"7721973","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10599.0,"discounted_cash":4239.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Suture Sz 1      222301 Gallies Facia Large","code_information":[{"code":"7721974","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 56Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7721975","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7186.0,"discounted_cash":2874.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Articul/Eze 40Mm +12Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7721976","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4395.0,"discounted_cash":1758.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 40X56Mm +4 Neutral Altrx","code_information":[{"code":"7721977","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10267.0,"discounted_cash":4106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Solution System 18Mmx8In Cementls Sm Stature Cocr Porocoat 12/14 Taper Strt","code_information":[{"code":"7721978","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17685.0,"discounted_cash":7074.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X85Mm Non-Locking Partial Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7721979","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X75Mm Non-Locking Lag Partial Thread Solid Cancell Timax Hex Drive F/Small Frag","code_information":[{"code":"7721980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polyax 5.5X95Mm Lck Full Thread Polyaxial Cancell Ti Dist Femur Ns","code_information":[{"code":"7721981","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 46Mm Unipol Modul Cathcart Ball Orthocentric Hip F/Fracture","code_information":[{"code":"7721982","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":429.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 62Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7721983","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5011.0,"discounted_cash":2004.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle Ultamet Xl 44X62Mm Neutral Cocr Metal","code_information":[{"code":"7721984","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14432.0,"discounted_cash":5772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 44Mm +1.5Mm Neck 12/14 Taper Contour M-Specification Metal","code_information":[{"code":"7721985","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12880.0,"discounted_cash":5152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Cement Post Stabil Oxinium Lt Knee","code_information":[{"code":"7721986","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16542.0,"discounted_cash":6616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 4X300Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7721987","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless 12X100Mm Z-Threaded Sleeve Handled F/Insufflation","code_information":[{"code":"7721988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Syringe Arterial Bg 963-3182 1Cc Cord Sampling","code_information":[{"code":"7721989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 7 Cement Post Stabil Tritanium Cocr Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7721990","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9021.0,"discounted_cash":3608.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 13Mm Artic Surface Post Stabil Bearing Uhmwpe Strl","code_information":[{"code":"7721991","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4554.0,"discounted_cash":1821.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Charlotte 1.6X150Mm Kirschner Temp Smooth Single-Ended Trocar Tip Ss Ankle","code_information":[{"code":"7721992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Darco 1.1X140Mm Kirschner Temp Smooth Trocar Point -  D","code_information":[{"code":"7721993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Staple Bone Fixat Charlotte 9Mm Lo-Pro Barbed Quick Interaxis Ss","code_information":[{"code":"7721994","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Ocg106","code_information":[{"code":"7721995","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Darco Bow Ii 5Mm Spacer Pre-Contoured Lck Open Wedge Lo-Pro Ti Anatomic Metatarsal Light","code_information":[{"code":"7721996","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5472.0,"discounted_cash":2188.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X20Mm Lck Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx Plate Fixat","code_information":[{"code":"7721997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X22Mm Lck Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx Plate Fixat","code_information":[{"code":"7721998","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X24Mm Lck Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx Plate Fixat","code_information":[{"code":"7721999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Allomatrix Dr Allograft Chips 3Ml Inject Scaffold Cancell Dbm Calcium Sulphate","code_information":[{"code":"7722000","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2545.0,"discounted_cash":1018.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 2X14Mm Self-Drilling/Tapping Snap-Off Smooth Head Ti Tarsometatarsal","code_information":[{"code":"7722001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"discounted_cash":384.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 2.0 X 20 Mm   Dc2825-120 Non Locking Screw 2.0 X 20 Mm","code_information":[{"code":"7722002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 8 85/59Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Rt Knee","code_information":[{"code":"7722003","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5460.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 8 Cement Post Stabil Oxinium Rt Knee","code_information":[{"code":"7722004","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11635.0,"discounted_cash":4654.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 5 42X145Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7722005","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12509.0,"discounted_cash":5003.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 3 Cement C/R Primary Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7722006","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8932.0,"discounted_cash":3572.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 3 13Mm Artic Surface Condylar Stabilizing Primary Lipped Bearing X3","code_information":[{"code":"7722007","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6367.0,"discounted_cash":2546.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Nester Hilal 2Mmx2Cm Pushable 3.2-Loop Synthetic Fiber Platin Mri-Cond 0.018In","code_information":[{"code":"7722008","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Microcoil Emboliz Tornado 4/2Mm P/D Taper 4Cm Pushable Sm End Existing Synthetic Fiber Platin","code_information":[{"code":"7722009","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Fathom-16 0.016Inx180Cm 25/10Cm Strt Tip Steer Pushable Ss Nitinol Platin Tungsten","code_information":[{"code":"7722010","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Microcatheter Vasc Renegade Emboliz 0.021In 3/2.5Fr P/D 150Cm 10Cm Fiber Braid Ultra Soft Hydro Pass","code_information":[{"code":"7722011","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":545.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Nexgen Legacy Size E 68/61.5Mm Cement Constrain Revis Zimaloy Non-Porous Lt Condylar","code_information":[{"code":"7722012","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18680.0,"discounted_cash":7472.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Size E Block Distally Pre-Coated Knee","code_information":[{"code":"7722013","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3388.0,"discounted_cash":1355.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur Nexgen Size E Std 5Mm Wedge/Block Tivanium Pmma Dist Knee Strl","code_information":[{"code":"7722014","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3297.0,"discounted_cash":1318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Nexgen 20X100Mm 145Mm Strt Pre-Coated Offst Flute Sharp Solid Tivanium Tibial Knee","code_information":[{"code":"7722015","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3550.0,"discounted_cash":1420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +9Mm Neck 12/14 Taper Modul Revis Biolox Delta Ts Hip","code_information":[{"code":"7722016","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9345.0,"discounted_cash":3738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coil Emboliz Mreye 5Mmx3Cm High Radial Force Pushable 1.9-Loop Inconel Synthetic Fiber Mri-Cond","code_information":[{"code":"7722017","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X56Mm Neutral Altrx","code_information":[{"code":"7722018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4590.0,"discounted_cash":1836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Nexgen Legacy Size Cd/5-6 12Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7722019","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5904.0,"discounted_cash":2361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4X22Mm Lck Self-Tap Cortic Ti Hex Head Light Blue Dist Humeral","code_information":[{"code":"7722020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 8/7Mm Long 260Mm Bend Cannul Antegrade/Retrograde Multi-Planar Humeral Ti Alloy Strl","code_information":[{"code":"7722021","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5749.0,"discounted_cash":2299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire #5 38In Ties Blue Ar-7210 Arthro Braid Uhmwpe W/O Needle Nonabsorbable","code_information":[{"code":"7722022","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":68.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 7-8 81-85Mm/56-59Mm 11Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722023","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Button Suture Endobutton Ti 12X4Mm Lf Arthro Contin Loop Strl","code_information":[{"code":"7722024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone A.L.P.S 109Mm 4-Hole Lck Timax Lt Dist Fibula Ns","code_information":[{"code":"7722025","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1966.0,"discounted_cash":786.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X18Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7722026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Gun Bone Cement Delivery","code_information":[{"code":"7722027","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nozzle Bone Cement Cortoss Tip Mix Luer F/Delivery","code_information":[{"code":"7722028","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plunger Bone Cement Aliquot 6In Vertebroplasty Injector F/Placement Weakened/Diminished","code_information":[{"code":"7722029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 7 Cement Constrain Revis Oxinium Rt Knee","code_information":[{"code":"7722032","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15817.0,"discounted_cash":6326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 14Mm Univ Short 80Mm Strt Revis Non-Slotted Press-Fit Primary Ti Knee","code_information":[{"code":"7722033","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2122.0,"discounted_cash":848.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Femur Legion Size 7 Std Univ 5Mm Primary Press-Fit Dist Knee W/Screw On","code_information":[{"code":"7722034","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2963.0,"discounted_cash":1185.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupler Spinal 6Mm Offst","code_information":[{"code":"7722035","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3275.0,"discounted_cash":1310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 6 Cement Stemmed Taper Revis Ti Porous Rt Knee Strl","code_information":[{"code":"7722036","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6920.0,"discounted_cash":2768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 18X120Mm Cementls Strt Revis Slot Primary Press-Fit Bilat Std Leg Ti Knee","code_information":[{"code":"7722037","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":1277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 74-77Mm/52-54Mm 21Mm Lt Rt Artic Surface Constrain Xlpe Strl","code_information":[{"code":"7722038","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5032.0,"discounted_cash":2012.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Trigen 6.4Mm 10Mm Ext Ti F/Intramedullary Nail","code_information":[{"code":"7722039","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":303.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 13X360Mm 130Deg Angle Cannul Lck Antegrad Rt Femur Trochan Ti Alloy Rose","code_information":[{"code":"7722040","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6705.0,"discounted_cash":2682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 6.4X105Mm Lck Inter Captured Cortic Ti Hex Head Blue Im Reconstruct F/Antegrade","code_information":[{"code":"7722041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 7 81/56Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Rt Knee","code_information":[{"code":"7722042","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8056.0,"discounted_cash":3222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Im 4.5Mm Compress Thread Olecranon","code_information":[{"code":"7722043","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2863.0,"discounted_cash":1145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Insert Joint Instrument Olecranon Thread","code_information":[{"code":"7722044","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nut Ortho 6Mm Compress Olecranon Strl","code_information":[{"code":"7722045","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":314.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 2Mm 9In Ss Ns","code_information":[{"code":"7722046","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Olecranon Rod Cannul Ns","code_information":[{"code":"7722047","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":799.0,"discounted_cash":319.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Olecranon Compress Nut","code_information":[{"code":"7722048","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":799.0,"discounted_cash":319.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Joint Instrument 1Mm Olecranon","code_information":[{"code":"7722049","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X26X9Mm Self-Distract Peek Ti Thoracolum Oblique","code_information":[{"code":"7722050","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14371.0,"discounted_cash":5748.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X24Mm Compress Lck Full Thread Self-Tap Cortic Ss Cruciform Recess Radial Wrist","code_information":[{"code":"7722051","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1.8X125Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End Gold Ss Ns F/Lcp Screw","code_information":[{"code":"7722052","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Charlotte 1X150Mm Kirschner Temp Smooth Single-Ended Trocar Tip Ss Ankle F/Ortholoc","code_information":[{"code":"7722053","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Mtp Fusion     4111-0005 Right Small Mtp Fusion Plate","code_information":[{"code":"7722054","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4312.0,"discounted_cash":1724.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 3X32Mm Cannul Compress Headless Self-Tapping/Drilling Short Dual Lead Thread Ss","code_information":[{"code":"7722055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Compression    4411-0011 30 Mm Comperssion Screw","code_information":[{"code":"7722056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 3.2X18Mm Non-Locking Fusion Ss Hex Head 1St Mtp Ankle Foot F/Lisfranc Frx Ns","code_information":[{"code":"7722057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Locon-T 2Mm Volar Jacobs Chuck End","code_information":[{"code":"7722058","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 2.7X14Mm Non-Locking Fusion Ss Hex Head 1St Mtp Ankle Foot F/Lisfranc Frx Ns","code_information":[{"code":"7722059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Locon-T 2.5Mm Volar Jacobs Chuck End","code_information":[{"code":"7722060","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 58Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7722062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6725.0,"discounted_cash":2690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X58Mm Neutral Altrx","code_information":[{"code":"7722063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4587.0,"discounted_cash":1834.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 36X62Mm Neutral Altrx","code_information":[{"code":"7722064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4590.0,"discounted_cash":1836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Pinnacle 62Mm Multi-Hole Bantam Primary Gription W/6.5Mm Dome Screw","code_information":[{"code":"7722065","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7669.0,"discounted_cash":3067.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur 36Mm +12Mm Neck 12/14 Taper Revis Modul Cocr","code_information":[{"code":"7722066","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3565.0,"discounted_cash":1426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 12X11Cm 6.3Cm 400Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7722067","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4400.0,"discounted_cash":1760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 13X12Cm 6.7Cm 500Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7722068","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4400.0,"discounted_cash":1760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 14X13Cm 7.1Cm 600Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7722069","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4400.0,"discounted_cash":1760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1.1Mm Mini 75Mm Quick-Coupling F/1.5Mm Cortex Screw","code_information":[{"code":"7722070","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 8-Hole H-Shaped Compress Lck Ss Adaption Limit-Cont Extend Rt F/1.5Mm Screw W/Short","code_information":[{"code":"7722071","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1577.0,"discounted_cash":630.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X18Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7722072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X24Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7722073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X20Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7722074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X16Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7722075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X15Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7722076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Full 200Mm Maxframe Ti F/Distraction Osteogenesis System Mri-Safe Ns","code_information":[{"code":"7722077","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4333.0,"discounted_cash":1733.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat 5/8 200Mm Maxframe Ti F/Distraction Osteogenesis System Mri-Safe Ns","code_information":[{"code":"7722078","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":1198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Long 120Mm Thread Slot Carbon Fiber F/Distraction Osteogenesis System Ns","code_information":[{"code":"7722079","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Long 150Mm Thread Slot Carbon Fiber F/Distraction Osteogenesis System Ns","code_information":[{"code":"7722080","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Long 200Mm Thread Slot Carbon Fiber F/Distraction Osteogenesis System Ns","code_information":[{"code":"7722081","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Wire Slot F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722082","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Wire Offst F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722083","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Extern Fixat 2X400Mm Smooth Tip F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722084","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Extern Fixat 2X400Mm Reduction F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722085","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Post Extern Fixat Short Wire F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722086","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":283.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Post Extern Fixat Tall Wire F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722087","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":322.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nut Extern Fixat Hex F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722088","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endobronch Broncho-Cath Shiley 32Frx3.4Mm Std 420Mm Lt Curve Dist Tip Cuffed 2Lumen Hi-Vol","code_information":[{"code":"7722089","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tube Endobronch Broncho-Cath Shiley 35Fr 4.8X11.7Mm Std 420Mm Lt Curve Dist Tip 2Lumen Cuffed Hi-Vol","code_information":[{"code":"7722090","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 4 Resurfac Primary Revis Cocr Lt Medial Rt Lat","code_information":[{"code":"7722091","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4377.0,"discounted_cash":1750.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 4 Resurfac Unicompart Primary Cocr Lt Medial Rt Lat","code_information":[{"code":"7722092","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7401.0,"discounted_cash":2960.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 8Mm Lt Medial Rt Lat Artic Surface X3 F/Partial Knee Resurfac Strl","code_information":[{"code":"7722093","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2864.0,"discounted_cash":1145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Transend 18 0.018Inx165Cm 2Cm Tip Shapeable Strt Steer Scitanium Tungsten Ice","code_information":[{"code":"7722094","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acufex Arthro 4.5Mm Femur Tunnel Cannul Reamer Head 30040 Strl F/Endobutton Cl Rci Screw","code_information":[{"code":"7722095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Femoral Head Sz 40 1365-70-100 Asphere M-Spec","code_information":[{"code":"7722096","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11968.0,"discounted_cash":4787.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 56Mm Multi-Hole Bantam Primary Gription W/6.5Mm Dome Screw","code_information":[{"code":"7722097","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7164.0,"discounted_cash":2865.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Solution System 13.5Mmx8In Cementls Sm Stature Cocr Porocoat 12/14 Taper Strt","code_information":[{"code":"7722098","type":"CDM"}],"standard_charges":[{"gross_charge":17685.0,"discounted_cash":7074.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Explant 48Mm  7053-48-10","code_information":[{"code":"7722099","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Explant Long  7053-48-20 48 Mm","code_information":[{"code":"7722100","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Joint Instrument Long Greater Trochan Cable-Ready Tivanium Extend Integral Reattachment","code_information":[{"code":"7722101","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7912.0,"discounted_cash":3164.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 6 Cement Constrain Revis Oxinium Lt Knee","code_information":[{"code":"7722102","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15817.0,"discounted_cash":6326.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 2X40Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722103","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 2.5X40Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722104","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 3.5X40Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722105","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 4X40Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722106","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 6X40Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722107","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 2.5X120Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722108","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 3X120Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 3.5X120Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722110","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 4X120Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722111","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 5X120Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722112","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat 6X120Mm 140Cm Rx Semi-Compli F/Pta 2-Longitudinal Wire","code_information":[{"code":"7722113","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat 7X120Mm 140Cm Rx Semi-Compli F/Pta 2-Longitudinal Wire","code_information":[{"code":"7722114","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 20X120Mm Cementls Strt Revis Slot Primary Press-Fit Bilat Std Leg Ti Knee","code_information":[{"code":"7722115","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":1277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 5 Cement Stemmed Taper Revis Ti Porous Lt Knee Strl","code_information":[{"code":"7722116","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6920.0,"discounted_cash":2768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupler Femur Legion +4Mm Stemmed Angle Offst Metal Back Knee","code_information":[{"code":"7722117","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3275.0,"discounted_cash":1310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 10Mm Univ Short 80Mm Strt Revis Non-Slotted Press-Fit Primary Ti Knee","code_information":[{"code":"7722118","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2494.0,"discounted_cash":997.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 16X120Mm Cementls Strt Revis Slot Primary Press-Fit Bilat Std Leg Ti Knee","code_information":[{"code":"7722119","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":1277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 74-77Mm/52-54Mm 9Mm Lt Rt Artic Surface Constrain Xlpe Strl","code_information":[{"code":"7722120","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5032.0,"discounted_cash":2012.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 6 42X145Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7722121","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12509.0,"discounted_cash":5003.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 50Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7722122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5011.0,"discounted_cash":2004.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 32X50Mm +4 Neutral Altrx","code_information":[{"code":"7722123","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4093.0,"discounted_cash":1637.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +5Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7722124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5078.0,"discounted_cash":2031.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone T2 5X90Mm Lck Full Thread Ti Stardrive Recess Greater Trochan Prox Femur Humeral Tibial","code_information":[{"code":"7722125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.0,"discounted_cash":262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 5X40Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722126","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Full 180Mm Maxframe Ti F/Distraction Osteogenesis System Mri-Safe Ns","code_information":[{"code":"7722127","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3992.0,"discounted_cash":1596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Half 180Mm Maxframe Ti F/Distraction Osteogenesis System Mri-Safe Ns","code_information":[{"code":"7722128","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":799.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foot Ring Extern Fixat 180Mm Long Carbon Fiber F/Distraction Osteogenesis System Mri-Cond Ns","code_information":[{"code":"7722129","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2798.0,"discounted_cash":1119.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Long 80Mm Thread Slot Carbon Fiber F/Distraction Osteogenesis System Ns","code_information":[{"code":"7722130","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nut Extern Fixat Rod Hex F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722131","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":10.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Conn F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722132","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Expert 3.5Mm Univ 440Mm Antegrad Elastic Tibial Ti Solid Light Blue F/Diaphyseal Frx Fixat","code_information":[{"code":"7722133","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":438.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4.5X195Mm Maxillofacial 3-Flute Qck-Conn Calib Ss Ns F/Lcp Fixat","code_information":[{"code":"7722134","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Genesis Ii Size 5-6 15Mm Compo Hemi Step Wedge/Block Revis Rt Medial Lt Lat W/Screw","code_information":[{"code":"7722135","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3222.0,"discounted_cash":1288.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Coupler Femur Legion +6Mm Stemmed Angle Offst Metal Back Knee","code_information":[{"code":"7722136","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3277.0,"discounted_cash":1310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 5 Cement Stemmed Taper Revis Ti Porous Rt Knee Strl","code_information":[{"code":"7722137","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6920.0,"discounted_cash":2768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Revere 6/7.5X30Mm Lck Polyaxial Dual Outer Diameter Cort/Canc Pedicle Ti Top Load","code_information":[{"code":"7722138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3176.0,"discounted_cash":1270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Glenoid Fixat Anatomical Shoulder 4Mm Pegged Modul Hybrid Post Uhmwpe","code_information":[{"code":"7722139","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":855.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Glenoid Fixat Anatomical Shoulder Sm 4Mm Pegged Modul Hybrid Uhmwpe","code_information":[{"code":"7722140","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":2159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Comprehensive 8Mm Std 122Mm Cement 45Deg Angle Morse Taper Primary Press-Fit Revers","code_information":[{"code":"7722141","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12996.0,"discounted_cash":5198.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Bio-Modular 4X48Mm Offst 19Mm Cocr","code_information":[{"code":"7722142","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5053.0,"discounted_cash":2021.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Vanguard 1/8In Knee Qr Strl","code_information":[{"code":"7722143","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Comprehensive 15/64In Glenoid Qck-Conn","code_information":[{"code":"7722144","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":670.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Bio-Modular/Comprehensive 4Mm Qck-Conn","code_information":[{"code":"7722145","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Corkscrew Ft 1.6X4Mm 2.2X4Mm Micro 4Mm W/2-0 Fiberwire 3/8Circle 1 Needle Ti Strl","code_information":[{"code":"7722146","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":421.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 3X40Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7722147","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 3 Cement Post Stabil Tritanium Cocr Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7722148","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9021.0,"discounted_cash":3608.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 3 19Mm Artic Surface Post Stabil Bearing Uhmwpe Strl","code_information":[{"code":"7722149","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4554.0,"discounted_cash":1821.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat 7X40Mm 140Cm Short Rx Semi-Compli F/Pta 2-Longitudinal","code_information":[{"code":"7722150","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Gel   3506001Bc Moderate Profile Plus Gel 600","code_information":[{"code":"7722151","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2879.0,"discounted_cash":1151.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Gel   3506501Bc Moderate Profile Plus Gel 650","code_information":[{"code":"7722152","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2879.0,"discounted_cash":1151.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Line Etco2 Sampling Microstream Advance Short-Term Std 6.5Ft Tubing Ped Adult Nasal Intubat","code_information":[{"code":"7722154","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Surg Kobygard Plantar Fascia Strl Disp","code_information":[{"code":"7722155","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4Mm Cannul F/G-Force","code_information":[{"code":"7722156","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference G-Force 4X15Mm Peek-Optima Thread Pull-Out F/Tenodesis Soft Tissue","code_information":[{"code":"7722157","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.0,"discounted_cash":736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sheath Interference Screw Bio-Intrafix Fastener Sm 30Mm Tcp Pla Absorb Tibial Acl Soft Tissue","code_information":[{"code":"7722158","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Bio-Intrafix 6-8X30Mm Tcp Pla Taper Thread Absorb F/Fastener 254660 Tibial Soft","code_information":[{"code":"7722159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":310.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Size 5 Cement Unicompart High Flexion Tivanium Rt Medial Lt Lat","code_information":[{"code":"7722160","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6949.0,"discounted_cash":2779.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Size 5 8Mm Net Shape Artic Surface Unicompart High Flexion Mold Uhmwpe Strl","code_information":[{"code":"7722161","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2937.0,"discounted_cash":1174.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 11.5X200Mm Cannul Lck Antegrade/Retrograde Lt Hindfoot Humeral Ti Alloy Fusion Lime","code_information":[{"code":"7722162","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9203.0,"discounted_cash":3681.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 43Mm Unipol Modul Cathcart Ball Orthocentric Hip F/Fracture","code_information":[{"code":"7722163","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":429.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Reamer 2.5X650Mm Femur Medullary Canal Ball Tip Deep Flute W/Extension 351.7095 Ss Strl","code_information":[{"code":"7722164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3.9/4.2Mm Short 150Mm 3-Flute Quick-Coupling Ss Ns F/5Mm Angular Stable Lck Screw","code_information":[{"code":"7722165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Drill 5Mm Resorb Poly Strl F/Angular Stable Lck Screw","code_information":[{"code":"7722166","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 10X330Mm Round Cannul Lck Tibial Ti Alloy Light Green Strl","code_information":[{"code":"7722167","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5001.0,"discounted_cash":2000.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X48Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Light Blue Femur","code_information":[{"code":"7722168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 10X315Mm Round Cannul Lck Tibial Ti Alloy Light Green Strl","code_information":[{"code":"7722169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5001.0,"discounted_cash":2000.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X38Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Light Blue Femur","code_information":[{"code":"7722170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X32Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Light Blue Femur","code_information":[{"code":"7722171","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X30Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Light Blue Femur","code_information":[{"code":"7722172","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X36Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Light Blue Femur","code_information":[{"code":"7722173","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X36Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7722174","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":312.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Expert 5X30Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti T25","code_information":[{"code":"7722175","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":312.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Endcap Ortho Expert Cannul T40 Stardrive Recess 0Mm Ext Dual Core Lck Screw Ti Tibial Gray F/Nail","code_information":[{"code":"7722176","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":274.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Liss 236Mm 9-Hole Contour Compress Lck Ti Fixed Angle Limit-Cont Lt Dist Femur F/5Mm","code_information":[{"code":"7722177","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":2329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X26Mm Cannul Lck Self-Drill Ti Hex Recess Conical Head Femur Radial Ns","code_information":[{"code":"7722178","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X40Mm Cannul Lck Self-Drill Ti Hex Recess Conical Head Femur Radial Ns","code_information":[{"code":"7722179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X55Mm Cannul Lck Self-Drill Ti Hex Recess Conical Head Femur Radial Ns","code_information":[{"code":"7722180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X65Mm Cannul Lck Self-Drill Ti Hex Recess Conical Head Femur Radial Ns","code_information":[{"code":"7722181","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 2X280Mm Kirschner Temp Spade Point Thread Ss Ns F/Liss","code_information":[{"code":"7722182","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Joint Instrument Lcp Push-Pull Reduction","code_information":[{"code":"7722183","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1161.0,"discounted_cash":464.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pusher Knot Fast-Fix Arthro Curve F/Meniscal/Tissue Repair System Knee","code_information":[{"code":"7722184","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +1.5Mm Neck 12/14 Taper Modul Total Stabil Biolox Delta Ts Hip","code_information":[{"code":"7722185","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9789.0,"discounted_cash":3915.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Human Tissue Strattice 60Sqcm 6X10Cm Regen Firm Reinforc Stoma Porcine Dermal Matrix Sheet","code_information":[{"code":"7722187","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":5833.0,"discounted_cash":2333.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle Ultamet Xl 40X60Mm Neutral Cocr Metal","code_information":[{"code":"7722188","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7670.0,"discounted_cash":3068.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X40Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7722189","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X42Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7722190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X20Mm Lck Thread Self-Tap Cortic Timax T15 Stardrive Recess Taper Head Purple","code_information":[{"code":"7722191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 6-Hole Narrow Pre-Contoured Compress Lck Timax Rt Dist Ant/Lat Tibial Ns","code_information":[{"code":"7722192","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3914.0,"discounted_cash":1565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Size F Unicompart High Flexion Zimaloy Rt Medial Lt Lat Knee","code_information":[{"code":"7722193","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11477.0,"discounted_cash":4590.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2Mm Long 28Mm Lck Perm Smooth Cocr Subchondral Volar Blue","code_information":[{"code":"7722194","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Extensure H2 16X30Mm Fresh In Saline Cervical","code_information":[{"code":"7722196","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7552.0,"discounted_cash":3020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Affix Ii 55Mm Ti Lumb Interspinous Ns","code_information":[{"code":"7722197","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14220.0,"discounted_cash":5688.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Extensure H2 12X30Mm Fresh In Saline Cervical","code_information":[{"code":"7722198","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7552.0,"discounted_cash":3020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Affix Ii 45Mm Ti Lumb Interspinous Ns","code_information":[{"code":"7722199","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14220.0,"discounted_cash":5688.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X380Mm 130Deg Angle Cannul Lck Antegrad Rt Femur Trochan Ti Alloy Rose","code_information":[{"code":"7722200","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6705.0,"discounted_cash":2682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 3.2Mm 343Mm Thread Brad Point Cocr Strl","code_information":[{"code":"7722201","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Twinfix 3.5Mm Preload Flat Inserter Hndl W/2-#2 Uhmwpe Ultrabraid Nonabsorbable Needle","code_information":[{"code":"7722202","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":291.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Stratafix Spiral Pdo Quill #1 36Cm 1/2 Circ Ctx Dbl-Arm Taper Point Violet 1 Strand/Pk","code_information":[{"code":"7722203","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat Jet-X F/10.5Mm Bar/Pin Ns","code_information":[{"code":"7722204","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2432.0,"discounted_cash":972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 44X64Mm +4 Neutral Altrx","code_information":[{"code":"7722205","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10642.0,"discounted_cash":4256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +1Mm Neck 12/14 Taper Modul Revis Biolox Delta Ts Hip","code_information":[{"code":"7722206","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9345.0,"discounted_cash":3738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Affix Ii 35Mm Ti Lumb Interspinous Ns","code_information":[{"code":"7722207","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14221.0,"discounted_cash":5688.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Extensure H2 8X30Mm Fresh In Saline Cervical","code_information":[{"code":"7722208","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7552.0,"discounted_cash":3020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Extensure H2 10X30Mm Fresh In Saline Cervical","code_information":[{"code":"7722209","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7552.0,"discounted_cash":3020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 13X340Mm 130Deg Angle Cannul Lck Antegrad Lt Femur Trochan Ti Alloy Lime","code_information":[{"code":"7722210","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6705.0,"discounted_cash":2682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Trigen Meta-Nail Pilot 4Mm Long 333Mm Ao Connect Strl Disp","code_information":[{"code":"7722211","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dressing Neg Press Wound 5X8In Antimic Contact Layer Lf Strl Disp F/Invia Liberty/Motion Npwt","code_information":[{"code":"7722212","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill 1.8Mm Qck-Conn Calib","code_information":[{"code":"7722213","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":507.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Sm 2.5X40Mm Cannul Partial Thread Self-Drilling/Tapping Ss Revers Cut Flute Trocar Tip Gw","code_information":[{"code":"7722214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":259.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Vlp Foot 0.9X150Mm Cannul Kirschner Temp Lck Trocar Tip Cocr Trochan F/2.5Mm Screw","code_information":[{"code":"7722215","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":60.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Sm 2.5X30Mm Cannul Partial Thread Self-Drilling/Tapping Ss Revers Cut Flute Trocar Tip Gw","code_information":[{"code":"7722216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":259.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Countersink Drill 2.5/3Mm Cannul Quick-Coupling Mercury-Free F/Small Screw","code_information":[{"code":"7722217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":302.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Sm 3X36Mm Cannul Partial Thread Self-Drilling/Tapping Ss Revers Cut Flute Drill Tip Gw","code_information":[{"code":"7722218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Sm 3X30Mm Cannul Partial Thread Self-Drilling/Tapping Ss Revers Cut Flute Drill Tip Gw Ns","code_information":[{"code":"7722219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Obturator             71177104","code_information":[{"code":"7722220","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Peri-Loc 2Mm Long 190Mm Dist Radial Volar Qck-Conn F/Large Frag Targeter","code_information":[{"code":"7722221","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill 2.7             71173502","code_information":[{"code":"7722222","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 2.7X24Mm Non-Locking Self-Tap Var Ang Std Cortic Ss Hex Recess Head Dist","code_information":[{"code":"7722223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc 80Mm 5-Hole Strt Contour Lck Ss Reconstruct Lt Post/Lat Dist Humeral F/3.5Mm","code_information":[{"code":"7722224","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3133.0,"discounted_cash":1253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 2.7X24Mm Lck Full Thread Self-Tap Cortic Ss Dist Volar Radial","code_information":[{"code":"7722225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X18Mm Lck Self-Tap Cortic Ss Dist Ant/Lat Tibial F/Locked Plate System","code_information":[{"code":"7722226","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 2.7X30Mm Non-Locking Self-Tap Var Ang Std Cortic Ss Hex Recess Head Dist","code_information":[{"code":"7722227","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X30Mm Non-Locking Self-Tap Cortic Ss Lat Prox Tibia F/Locked Plate System","code_information":[{"code":"7722228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X32Mm Lck Self-Tap Cortic Ss Dist Ant/Lat Tibial F/Locked Plate System","code_information":[{"code":"7722229","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Peri-Loc 2.7X18Mm Provision Temp Lck Ss Periarticular","code_information":[{"code":"7722230","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":183.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc 103Mm 7-Hole Contour Lck Ss Lt Medial Dist Humeral F/2.7/3.5Mm Screw","code_information":[{"code":"7722231","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3395.0,"discounted_cash":1358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 2.7X40Mm Lck Full Thread Self-Tap Cortic Ss Dist Volar Radial","code_information":[{"code":"7722232","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X22Mm Lck Self-Tap Cortic Ss Dist Ant/Lat Tibial F/Locked Plate System","code_information":[{"code":"7722233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X28Mm Non-Locking Self-Tap Cortic Ss Lat Prox Tibia F/Locked Plate System","code_information":[{"code":"7722234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill 3.5             71173504","code_information":[{"code":"7722235","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X20Mm Lck Self-Tap Cortic Ss Dist Ant/Lat Tibial F/Locked Plate System","code_information":[{"code":"7722236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 2.7X36Mm Lck Full Thread Self-Tap Cortic Ss Dist Volar Radial","code_information":[{"code":"7722237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 2.7X18Mm Lck Full Thread Self-Tap Cortic Ss Dist Volar Radial","code_information":[{"code":"7722238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X34Mm Lck Self-Tap Cortic Ss Dist Ant/Lat Tibial F/Locked Plate System","code_information":[{"code":"7722239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X34Mm Non-Locking Self-Tap Cortic Ss Lat Prox Tibia F/Locked Plate System","code_information":[{"code":"7722240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 2.7X34Mm Lck Full Thread Self-Tap Cortic Ss Dist Volar Radial","code_information":[{"code":"7722241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X14Mm Lck Self-Tap Cortic Ss Dist Ant/Lat Tibial F/Locked Plate System","code_information":[{"code":"7722242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X30Mm Lck Self-Tap Cortic Ss Dist Ant/Lat Tibial F/Locked Plate System","code_information":[{"code":"7722243","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 18/24Mm P/D 8.5Cm Flared Woven Iliac Ext Cuff","code_information":[{"code":"7722244","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11985.0,"discounted_cash":4794.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Feeding Tube 12 Fr  Pegj-12-24 12 Fr 60 Cms X 260 Cms","code_information":[{"code":"7722245","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Lpt Size 1 Reg Cocr Ti Non-Porous Mtp Great","code_information":[{"code":"7722246","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8641","type":"HCPCS"}],"standard_charges":[{"gross_charge":5569.0,"discounted_cash":2227.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Lpt 1.4Mmx3In Cannul Kirschner Temp Thread Round Ended Trocar Point","code_information":[{"code":"7722247","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Saw 9.0X12.5 13090127Lf1 Must Order Quantity Of 5 Ea","code_information":[{"code":"7722248","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X6Mm Cortic Ti Self-Tap Coarse Pitch Gold F/Curvilinear Distract System Cmf Ns","code_information":[{"code":"7722249","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X8Mm Cortic Ti Self-Tap Coarse Pitch Gold F/Curvilinear Distract System Cmf Ns","code_information":[{"code":"7722250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Mini 4-Hole 1Mm Lck Ti Malleab F/2Mm Screw Mandibular Ns","code_information":[{"code":"7722251","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":404.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7722252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cup Acetabular Continuum Size Jj 52Mm Cluster-Hole Hemis Snap-Fit Lck Groove Trabecul Metal Tivanium","code_information":[{"code":"7722253","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10871.0,"discounted_cash":4348.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Continuum Size Ii 36X52Mm 6.7Mm Elevated Longevity Hxlpe Strl","code_information":[{"code":"7722254","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5498.0,"discounted_cash":2199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Ringloc 36Mm Short +0Mm Neck 6Deg Angle Taper Anatomic Revis Press-Fit Cocr Hip Strl","code_information":[{"code":"7722255","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3366.0,"discounted_cash":1346.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 184Mm 9-Hole Contour Lck Timax Rt Medial Dist Tibial F/3.5Mm Screw Ns","code_information":[{"code":"7722256","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4173.0,"discounted_cash":1669.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X55Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7722257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reamer Hand Trufuse","code_information":[{"code":"7722258","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1760.0,"discounted_cash":704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Trufuse Steinmann Temp","code_information":[{"code":"7722259","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size E Std 68/61.5Mm Post Stabil Zimaloy Porous Rt Striped Yellow","code_information":[{"code":"7722260","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15098.0,"discounted_cash":6039.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Nexgen Mis Size 5 Modul Fixed Bearing Stemmed Trabecul Metal Porous Knee","code_information":[{"code":"7722261","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10822.0,"discounted_cash":4328.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +9Mm Neck 12/14 Taper Modul Cocr Hip","code_information":[{"code":"7722262","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2084.0,"discounted_cash":833.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Introducer Cath Mak-Nv Mini Access 6Frx20Cm Coaxial W/0.018In 60Cm Nt/Pt 0.038In 150Cm 3Mm J-Tip","code_information":[{"code":"7722263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Urethral Lubri-Sil Foley Specialty 22Fr 30Ml Bln Short Round Tip 3-Way 2-Opposing Eye","code_information":[{"code":"7722264","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Microcoil Emboliz Nester Hilal 3Mmx3Cm Pushable 3.2-Loop Synthetic Fiber Platin Mri-Cond 0.018In","code_information":[{"code":"7722265","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Microcoil Emboliz Nester 12Mmx14Cm Pushable 3.7-Loop Synthetic Fiber Platin Mri-Cond 0.035In Cath","code_information":[{"code":"7722266","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Tornado 10/5Mm P/D 12.5Cm Pushable Sm End Existing Synthetic Fiber Platin Mri-Cond","code_information":[{"code":"7722267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Embolization Tornado 7/3Mm P/D 9Cm Pushable Small End Existing Synthetic Fiber Platinum Mr","code_information":[{"code":"7722268","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Tornado 10/4Mm P/D 14.2Cm Pushable Sm End Existing Synthetic Fiber Platin Mri-Cond","code_information":[{"code":"7722269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcoil Emboliz Tornado 8/4Mm P/D 8Cm Pushable Sm End Existing Synthetic Fiber Platin Mri-Cond","code_information":[{"code":"7722270","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 8 11Mm Artic Surface C/R Fixed Bearing X3 F/Total Knee Arthropl","code_information":[{"code":"7722271","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6036.0,"discounted_cash":2414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Spinal Transition Lck Post","code_information":[{"code":"7722272","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":350.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Transition 28Mm Lordosed 2Lvl Strl","code_information":[{"code":"7722273","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8984.0,"discounted_cash":3593.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Transition 26Mm Lordosed 2Lvl Strl","code_information":[{"code":"7722274","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8984.0,"discounted_cash":3593.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 2Mm Micro 20Mm Cannul Compress Headless Full Wide Thread Strl - D","code_information":[{"code":"7722275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":663.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 58Mm Unipol Modul Cathcart Ball Orthocentric Hip F/Fracture","code_information":[{"code":"7722276","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":429.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Long 300Mm Thread Slot Carbon Fiber F/Distraction Osteogenesis System Ns","code_information":[{"code":"7722277","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 32/14Mm P/D 155Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7722278","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30516.0,"discounted_cash":12206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Long 350Mm Thread Slot Carbon Fiber F/Distraction Osteogenesis System Ns","code_information":[{"code":"7722279","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat 5/8 200Mm Maxframe Carbon Fiber F/Distraction Osteogenesis System Mri-Safe Ns","code_information":[{"code":"7722280","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2398.0,"discounted_cash":959.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foot Ring Extern Fixat 200Mm Long Ti F/Distraction Osteogenesis System Mri-Cond Ns","code_information":[{"code":"7722281","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3821.0,"discounted_cash":1528.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Grasper Endo Talon Device 2.5Mm Sheath 160Cm 4-Prong Inward Facing Hook Ss Strl Disp F/Foreign Body","code_information":[{"code":"7722282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Guiding Recon Support 6Frx110Cm Angle","code_information":[{"code":"7722283","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Porter 0.014Inx300Cm 3Cm Strt Tip Spring Coil Steer Platin Alloy Hydrphil Ptfe 6Gm","code_information":[{"code":"7722284","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Occlus Crosser Iq Cto 5Frx146Cm Otw Hndl 0.014In Gw 5Fr Sheath","code_information":[{"code":"7722285","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7309.0,"discounted_cash":2923.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Leadwire Electrotherapy Pacemaker Reliable Lo-Pro Low Chronic Threshold Post-Op Fractal Coat","code_information":[{"code":"7722286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2239.0,"discounted_cash":895.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 8 Cement Post Stabil Oxinium Lt Knee","code_information":[{"code":"7722287","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17544.0,"discounted_cash":7017.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 8 85/59Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Lt Knee","code_information":[{"code":"7722288","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8056.0,"discounted_cash":3222.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 7-8 81-85Mm/56-59Mm 15Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722289","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3701.0,"discounted_cash":1480.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Lg 10X10X35Mm Expand Tooth Peek Post Lumb 5Deg Oblique Ns","code_information":[{"code":"7722290","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14420.0,"discounted_cash":5768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X35Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7722291","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":679.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Ii 6.5X40Mm Polyaxial Ti Post Pedicle Thoracolum","code_information":[{"code":"7722292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3022.0,"discounted_cash":1208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Ii Lck Ss","code_information":[{"code":"7722293","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X400Mm 130Deg Angle Cannul Lck Antegrad Reconstruct Rt Femur Trochan Ti Alloy","code_information":[{"code":"7722294","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6199.0,"discounted_cash":2479.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 47Mm Unipol 12/14 Taper Primary Endoprosthesis Zimaloy Hip Strl","code_information":[{"code":"7722295","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1974.0,"discounted_cash":789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 40Mm +8.5Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7722296","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11968.0,"discounted_cash":4787.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle Ultamet Xl 40X58Mm Neutral Cocr Metal","code_information":[{"code":"7722297","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7670.0,"discounted_cash":3068.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/24Mm P/D 105Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7722298","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14462.0,"discounted_cash":5784.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 28/16Mm P/D 140Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7722299","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27959.0,"discounted_cash":11183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Liss 236Mm 9-Hole Contour Compress Lck Ti Fixed Angle Limit-Cont Rt Dist Femur F/5Mm","code_information":[{"code":"7722301","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":2329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X75Mm Cannul Lck Self-Drill Ti Hex Recess Conical Head Femur Radial Ns","code_information":[{"code":"7722302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reamer Surg G-Force 7Mm Forefoot Cannul","code_information":[{"code":"7722303","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":310.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference G-Force 7X25Mm Peek-Optima Thread Pull-Out F/Tenodesis Soft Tissue","code_information":[{"code":"7722304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.0,"discounted_cash":736.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Zuk Size 3 8Mm Net-Shaped Artic Surface Unicompart High Flexion Mold Uhmwpe Strl","code_information":[{"code":"7722305","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1173.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +1.5Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7722306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5358.0,"discounted_cash":2143.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Summit Size 8 50X160Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7722307","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12509.0,"discounted_cash":5003.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Pinnacle 6.5X40Mm Dome Self-Tap Polyaxial Gription Ti Foam Cancell Strl","code_information":[{"code":"7722308","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Natrelle 13.5X14.6Cm 5.5Cm 530Ml Saline-Filled Texture Post Diaphragm Vlv Full","code_information":[{"code":"7722309","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":1024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Natrelle 14.6X15.6Cm 5.8Cm 655-690Ml Saline-Filled Texture Post Diaphragm Vlv Full","code_information":[{"code":"7722310","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":1024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X12Mm Cortic Ti Self-Tap Coarse Pitch Gold F/Curvilinear Distract System Cmf","code_information":[{"code":"7722313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2.4X12Mm Emergency Ti Self-Tap Teal Cmf Ns","code_information":[{"code":"7722314","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":83.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ligasure 5Mm 37Cm       Lf1837","code_information":[{"code":"7722315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1523.0,"discounted_cash":609.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Arthro 1.4Mm Soft Tissue Strt W/Guide/Rigid Drill Bit Strl Disp F/Juggerknot Anchor","code_information":[{"code":"7722316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":328.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Juggerknot 1.4Mm Single-Loaded Soft W/#1 Maxbraid Guide Drill Strl","code_information":[{"code":"7722317","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":404.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Independence Angle Self-Centering","code_information":[{"code":"7722318","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3515.0,"discounted_cash":1406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Med 34X15X26Mm 15Deg Lordot","code_information":[{"code":"7722319","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":36595.0,"discounted_cash":14638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortoss Cartridge    2101-0005 5Cc Cortoss Cartridge","code_information":[{"code":"7722320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2560.0,"discounted_cash":1024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 44Mm +15.5Mm Neck 12/14 Taper Contour M-Specification Metal","code_information":[{"code":"7722321","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4560.0,"discounted_cash":1824.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 44X62Mm +4 Neutral Altrx","code_information":[{"code":"7722322","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10642.0,"discounted_cash":4256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Quickset Pinnacle 6.5X35Mm 1Pc Qck-Conn Flex Ns","code_information":[{"code":"7722323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1636.0,"discounted_cash":654.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Venaflo Av Access     Cvl5006C","code_information":[{"code":"7722324","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3513.0,"discounted_cash":1405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Extern Fixat Long 100Mm Thread Slot Carbon Fiber F/Distraction Osteogenesis System Ns","code_information":[{"code":"7722325","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Extern Fixat Long Conn F/Distraction Osteogenesis Ring System Mri-Safe Ns","code_information":[{"code":"7722326","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Foot Ring Extern Fixat 180Mm Long Ti F/Distraction Osteogenesis System Mri-Cond Ns","code_information":[{"code":"7722327","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":1475.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cortoss Cartridge    2101-0010 10 Cc Cortoss Cartridge","code_information":[{"code":"7722328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4796.0,"discounted_cash":1918.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head 22.0Mm Left    Tr-H22Ol-S Cobalt Chromium","code_information":[{"code":"7722329","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7977.0,"discounted_cash":3190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Elbow Joint 8X25Mm +0Mm Offst Collar Ti Radial F/Arh Solutions 2 System Strl","code_information":[{"code":"7722330","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9030.0,"discounted_cash":3612.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 32X52Mm Neutral Altrx","code_information":[{"code":"7722331","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3715.0,"discounted_cash":1486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Surgibit 2Mm Long 6.25In Qr Ns F/Congruent Elbow System","code_information":[{"code":"7722332","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat 2.8Mm Steinmann Temp Smooth Qr Lck Plain Trocar Point Elbow","code_information":[{"code":"7722333","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate 11 Hole Locking Pl-Le011 Locking Olecranon Plate","code_information":[{"code":"7722334","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3695.0,"discounted_cash":1478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X22Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7722335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X50Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7722336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Crosser 14Potw        Cruo14Pa","code_information":[{"code":"7722337","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7676.0,"discounted_cash":3070.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Extern Fixat Schanz 5Mm Lg 150Mm 60Mm Thread Self-Drill Blunt Trocar Point Chondral Hip Femur","code_information":[{"code":"7722338","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":564.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pin Bone Fixat 5X200Mm Steinmann Temp Smooth Plain Trocar Point Ss W/Central Thread Ns F/Large","code_information":[{"code":"7722339","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 32X54Mm Neutral Altrx","code_information":[{"code":"7722340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3715.0,"discounted_cash":1486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Baseplate Tibial Genesis Ii Size 5 74/52Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Lt Knee","code_information":[{"code":"7722341","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8080.0,"discounted_cash":3232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Omnifit Hfx Size 10 42Mm Offst 160Mm Cement Primary Reconstruct Cocr 132Deg Angle 35Mm","code_information":[{"code":"7722342","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4376.0,"discounted_cash":1750.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 4.3X30Mm Cannul Compress Headless Self-Tapping/Drilling Short Dual Lead Thread","code_information":[{"code":"7722343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 4.3X34Mm Cannul Compress Headless Self-Tapping/Drilling Short Dual Lead Thread","code_information":[{"code":"7722344","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 4.3X44Mm Cannul Compress Headless Self-Tapping/Drilling Short Dual Lead Thread","code_information":[{"code":"7722345","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3Mm Ankle Cannul Jacobs Chuck End Compress Strl F/Charlotte 4.3Mm Multi-Use Screw F A","code_information":[{"code":"7722346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 3Mm Ankle Cannul Jacobs Chuck End Compress Strl F/Charlotte 4.3Mm Multi-Use Headed Screw F","code_information":[{"code":"7722347","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 3X18Mm Cannul Compress Headless Self-Tapping/Drilling Short Dual Lead Thread Ss","code_information":[{"code":"7722348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Ankle Cannul Jacobs Chuck End Compress Strl F/Charlotte 3Mm Multi-Use Screw F A System","code_information":[{"code":"7722349","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Genesis Ii Size 6 Post Stabil Oxinium Non-Porous Rt","code_information":[{"code":"7722350","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11635.0,"discounted_cash":4654.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 2 64/45Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Rt Knee","code_information":[{"code":"7722351","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7595.0,"discounted_cash":3038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microsheath Xl Str   Msxl17110","code_information":[{"code":"7722353","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1044.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Cement Constrain Revis Oxinium Lt Knee","code_information":[{"code":"7722354","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15818.0,"discounted_cash":6327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 3-4 68-71Mm/48-50Mm 18Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722355","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3704.0,"discounted_cash":1481.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 15X120Mm Cementls Strt Revis Slot Primary Press-Fit Bilat Std Leg Ti Knee","code_information":[{"code":"7722356","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3194.0,"discounted_cash":1277.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +5Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7722357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5021.0,"discounted_cash":2008.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 8 Cementls C/R Bead Tritanium Cocr Peri-Apatite Lt F/Total Knee","code_information":[{"code":"7722358","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13845.0,"discounted_cash":5538.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 8 9Mm Artic Surface Stabil Lipped Constrain Bearing Pe F/Total Knee","code_information":[{"code":"7722359","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5389.0,"discounted_cash":2155.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Solution System 15Mmx8In Cementls Sm Stature Cocr Porocoat 12/14 Taper Strt","code_information":[{"code":"7722360","type":"CDM"}],"standard_charges":[{"gross_charge":17685.0,"discounted_cash":7074.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Joint Instrument Short Greater Trochan Cable-Ready Tivanium Extend Integral Reattachment","code_information":[{"code":"7722361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4934.0,"discounted_cash":1973.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 24X18Mm Sm X-Shaped Contour Compress Lck Lo-Pro Ss Foot F/2.4/2.7Mm Screw Ns","code_information":[{"code":"7722362","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":1100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X22Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Green Dist","code_information":[{"code":"7722363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X24Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Green Dist","code_information":[{"code":"7722364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":160.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X18Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Green Dist","code_information":[{"code":"7722365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":160.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 16X28Mm 4-Hole Short H-Shaped Flat Lck Ti Rt Ankle Strl","code_information":[{"code":"7722366","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Bone Graft Hatric 2X7Mm Void Filler Tcp","code_information":[{"code":"7722367","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Lp 3.5X30     Ar-8935-30","code_information":[{"code":"7722368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Kreulock 3.5X34Mm Non-Locking Full Thread Self-Drill Lo-Pro Cortic Ti T15 Hexalobe Drive","code_information":[{"code":"7722369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X30Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ti T15 Hexalobe Drive Blue Wrist Hand","code_information":[{"code":"7722370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X34Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ti T15 Hexalobe Drive Blue Wrist Hand","code_information":[{"code":"7722371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 2.5Mm Cervical Foot Ankle Lf F/Midfoot Plate Module","code_information":[{"code":"7722372","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Fps Pilot 2.4Mm F/3.5Mm/4Mm Screw","code_information":[{"code":"7722373","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Fps Lg Medial Column F/3.5/4Mm Screw","code_information":[{"code":"7722374","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1088.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 3.5X24Mm Lck Std Ti Magenta Foot F/Small Frag System Ns","code_information":[{"code":"7722375","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 3.5X38Mm Lck Std Ti Magenta Foot F/Small Frag System Ns","code_information":[{"code":"7722376","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 3.5X20Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7722377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 3.5X26Mm Lck Std Ti Magenta Foot F/Small Frag System Ns","code_information":[{"code":"7722378","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 3.5X26Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7722379","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X36Mm Lck Std Ti Magenta Foot F/Small Frag System Ns","code_information":[{"code":"7722380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X26Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7722381","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X36Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7722382","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Size 5 9Mm Net Shape Artic Surface Unicompart High Flexion Mold Uhmwpe Strl","code_information":[{"code":"7722383","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2937.0,"discounted_cash":1174.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Sm 30X11X24Mm 15Deg Lordot","code_information":[{"code":"7722384","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":36595.0,"discounted_cash":14638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Sm 30X15X24Mm 8Deg Lordot","code_information":[{"code":"7722385","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":36595.0,"discounted_cash":14638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Uhr 28X58Mm Univ Bipol Bevel Tip Primary 1Pc Lck Cocr Uhmwpe Hip Strl","code_information":[{"code":"7722386","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":1226.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 86Mm 4-Hole Pre-Contoured Compress Lck Ss Lt Lat Dist Fibula F/2.7/3.5Mm Screw Ns","code_information":[{"code":"7722388","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2127.0,"discounted_cash":850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Femur Articul/Eze +0Mm Neck Unipol 12/14 Taper Modul Cathcart Hip","code_information":[{"code":"7722389","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X360Mm 130Deg Angle Cannul Lck Antegrad Rt Femur Trochan Ti Alloy Rose","code_information":[{"code":"7722390","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6705.0,"discounted_cash":2682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx110Cm 145Deg Ang Van Tassel Pig 6Sh 3-Stage Braid","code_information":[{"code":"7722391","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dressing Nasal Sinu-Foam Stammberger 7.5Cm Ant Air-Inflatable Dissolvable Bln No-Airway High Absorb","code_information":[{"code":"7722392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Optitorque 5Frx100Cm Rad Tig4 1Sh Dbl Braid Coaxial High Flow Coronary Nylon","code_information":[{"code":"7722393","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Optitorque 5Frx110Cm Rad Tig4 1Sh Dbl Braid Coaxial High Flow Coronary Nylon","code_information":[{"code":"7722394","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Optitorque 5Frx100Cm Jacky R3.5 2Sh Dbl Braid Coaxial Lg Lumen High Flow","code_information":[{"code":"7722395","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Optitorque 5Frx110Cm Sarah Rad4 2Sh Dbl Braid Coaxial High Flow Coronary Nylon","code_information":[{"code":"7722396","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tr Band Reg 24Cm     Trb24-Reg","code_information":[{"code":"7722397","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tr Band Long 29Cm    Trb29-Lrg","code_information":[{"code":"7722398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Closesure Device     Cti-1015P Carter Thompson","code_information":[{"code":"7722399","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tip Manipulator Rumi Ii 6.7Mmx8Cm 2In Shaft Intrauterine Flex Dist End Koh Blue Silicone Lf Strl","code_information":[{"code":"7722400","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tip Manipulator Rumi Ii 6.7Mmx6Cm 2In Shaft Intrauterine Flex Dist End Koh White Silicone Lf Strl","code_information":[{"code":"7722401","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tip Manipulator Rumi Ii 6.7Mmx10Cm 2In Shaft Intrauterine Flex Dist End Koh Green Silicone Lf Strl","code_information":[{"code":"7722402","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tip Manipulator Rumi Ii 5.1Mmx6Cm 2In Shaft Intrauterine Flex Dist End Koh Lavender Silicone Lf Strl","code_information":[{"code":"7722403","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Burr Surg 2X30Mm 6Mm Flute Spinal Round E9000 Ss Strl F/Otology Neuro","code_information":[{"code":"7722404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 6.5X30Mm 10Mm Flute Spinal Round Low Speed Optimum E9000 Carbide Strl F/Otology Neuro","code_information":[{"code":"7722405","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Flexi Tip         G17323 Dual Lumen 6Fr/10Fr","code_information":[{"code":"7722406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Guide Stiff Ultra  G09957 Amplatz","code_information":[{"code":"7722407","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Balloon Ureteral Dil    G32837 Ascen","code_information":[{"code":"7722408","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Ankle Joint Horizon 9Mm Conical Soft Thread Ti Subtalar","code_information":[{"code":"7722409","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":1598.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp Extern Fixat 4-Hole Pin Quick-Coupling Dist Radial Foot Jet-X F/Unilateral Bar System Ns","code_information":[{"code":"7722410","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1802.0,"discounted_cash":720.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 6.4X100Mm Lck Inter Captured Cortic Ti Hex Head Blue Im Reconstruct F/Antegrade","code_information":[{"code":"7722411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 6.4X90Mm Lck Inter Captured Cortic Ti Hex Head Blue Im Reconstruct F/Antegrade","code_information":[{"code":"7722412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 11.5X420Mm 130Deg Angle Cannul Lck Antegrad Lt Femur Trochan Ti Alloy Lime","code_information":[{"code":"7722413","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6705.0,"discounted_cash":2682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extractor Surg 3X120Mm Trigen Meta-Nail Plastic Disp","code_information":[{"code":"7722414","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":313.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im T2 11X280Mm Cannul Lck Antegrade/Retrograde Femur Ti Alloy Strl","code_information":[{"code":"7722415","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5262.0,"discounted_cash":2104.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cable Ortho 1.8X914Mm Grip System Cocr Ceramic W/Crimp","code_information":[{"code":"7722416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Monoglide Rd Quick Load 2-0 53In 021030 Monofil Polydioxanone Absorb","code_information":[{"code":"7722417","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":65.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Graf Bif    Af3216C170Xh","code_information":[{"code":"7722418","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":28518.0,"discounted_cash":11407.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Iliac Ext Cf 14X14 Iexch141455","code_information":[{"code":"7722419","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7671.0,"discounted_cash":3068.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mri Port Attachable    0602270 9.6 French","code_information":[{"code":"7722420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.0,"discounted_cash":373.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Al1 Nsh 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7722421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm Al2 Nsh 3-Stage Braid Thrulumen Soft Tip Coronary","code_information":[{"code":"7722422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Angiographic Infiniti Selective 5Frx100Cm 3-Stage Braid Thrulumen Soft Tip Lcb Coronary","code_information":[{"code":"7722423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Introducer Cath Glidesheath Slender Access 5Frx10Cm Strt X-Cut Vlv Radial W/0.025In 45Cm Plastic","code_information":[{"code":"7722424","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Darco 1.1X140Mm Kirschner Temp Smooth Trocar Point","code_information":[{"code":"7722425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Ao F/Darco Mfs System","code_information":[{"code":"7722426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Darco 35Mm 6-Hole 2-Slot Med Compress Lck Ti Mtp Light Blue Ns","code_information":[{"code":"7722427","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5221.0,"discounted_cash":2088.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X16Mm Non-Locking Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx","code_information":[{"code":"7722428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X14Mm Non-Locking Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx","code_information":[{"code":"7722429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X12Mm Non-Locking Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx","code_information":[{"code":"7722430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X18Mm Non-Locking Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx","code_information":[{"code":"7722431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Classic Chs 204Mm 10-Hole 95Deg Angle Compress 25.4Mm Barrel Supracond Hip","code_information":[{"code":"7722432","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":1148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Urethral Rusch Simplastic Foley Couvelaire 22Frx16In 30Ml Bln Coude Tip 3-Way Indwell Lg","code_information":[{"code":"7722433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Urethral Rusch Simplastic Foley Couvelaire 24Frx16In 30Ml Bln Coude Tip 3-Way Indwell Lg","code_information":[{"code":"7722434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Articul/Eze 32Mm +9Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7722435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4758.0,"discounted_cash":1903.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Langston 6Fr 110Cm 145Deg Pigtail 13Sh Coronary 2-Lumen Braided Low-Profile Mu","code_information":[{"code":"7722436","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Classic Chs 80Mm 3-Hole 130Deg Angle Compress Std Barrel Hip","code_information":[{"code":"7722437","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1611.0,"discounted_cash":644.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys Size 14 135Mm Cement Low Demand/Fracture Zimaloy 12/14 Taper Hip Strl","code_information":[{"code":"7722438","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6707.0,"discounted_cash":2682.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Centralizer Stem Versys 15Mm Cement Press-Fit Pmma Dist Femur Hip Strl","code_information":[{"code":"7722439","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Arthro Passing 2.4Mmx15In 4-Hole Laser-Marked Pad Velcro Strap F/Drill Tip Endobutton Pass","code_information":[{"code":"7722440","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Laser Fiber Holmium     G48626 Single Use","code_information":[{"code":"7722441","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2858.0,"discounted_cash":1143.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Soft 6Fr X 24Cm   G49973 Universa","code_information":[{"code":"7722442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extractor Stone 1.7Fr   G48294 Nitinol","code_information":[{"code":"7722443","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 48Mm No-Hole Primary Lck Ring Solid Porocoat 100 Series","code_information":[{"code":"7722444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5011.0,"discounted_cash":2004.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Guiding Trailblazer Support Push Dx 5Frx150Cm Strt Taper 50Mm Band Space Periph Lo-Pro","code_information":[{"code":"7722445","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 6 Cement Post Stabil Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7722446","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9021.0,"discounted_cash":3608.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 9Mm Artic Surface Post Stabil Bearing Uhmwpe Strl","code_information":[{"code":"7722447","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4554.0,"discounted_cash":1821.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Retractor Surg Mars 3V Prosthesis Bolt Sundrie Screw Pin Plate","code_information":[{"code":"7722448","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11508.0,"discounted_cash":4603.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Instrument Spinal Access F/Pedicle","code_information":[{"code":"7722449","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4550.0,"discounted_cash":1820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Forceps Electrosurgical Bipol 10.5In 1Mm Tip Bayonet Knife Strl F/Annulotomy","code_information":[{"code":"7722450","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Transcontinental Xs 18X40X9Mm Self-Distract Peek Lat Lumb 0Deg","code_information":[{"code":"7722451","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Transcontinental Xl 18X60X13Mm Self-Distract Peek Lat Lumb 0Deg","code_information":[{"code":"7722452","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Transcontinental Xl 18X60X9Mm Self-Distract Peek Lat Lumb 0Deg","code_information":[{"code":"7722453","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23965.0,"discounted_cash":9586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hook Ultrasonic Harmonic Dissect Scalpel 5Mmx32Cm Adaptive","code_information":[{"code":"7722455","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":318.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Adapter Ultrasonic Harmonic Hand Switch Disp F/Ees Hp054","code_information":[{"code":"7722456","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":72.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sealer Lap Enseal Adv Bipol Forceps 35Cm Curve Round Smooth Cut Coagulated Insul Rf Dissect Tip","code_information":[{"code":"7722457","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1581.0,"discounted_cash":632.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Coronary Multi-Link Mini Vision 2X28Mm 143Cm Cath Rx Bln-Expand Pre-Mount Non-Compli-D","code_information":[{"code":"7722458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4796.0,"discounted_cash":1918.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.5X50Mm Lck Inter Captured Cortic Ti Hex Head Gray Im F/8.5Mm","code_information":[{"code":"7722459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 8.5Mm Std 340Mm Antegrade/Retrograde Femur Tibial Knee Ti Alloy Gray","code_information":[{"code":"7722460","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6292.0,"discounted_cash":2516.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.5X35Mm Lck Inter Captured Cortic Ti Hex Head Gray Im F/8.5Mm","code_information":[{"code":"7722461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Nail Im Gamma3 11Mm Dist Long 2Mm Radius 440Mm 130Deg Angle Lck Rt Femur Trochan Ti Alloy W/Set","code_information":[{"code":"7722462","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7072.0,"discounted_cash":2828.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Graftjacket Std 4X7Cm 1.1Mm Regen Acell Dermal Matrix","code_information":[{"code":"7722463","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8123.0,"discounted_cash":3249.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Button Suture Toggleloc Femur Acl/Pcl W/Ziploop 3.2Mm 5In Solid/4.5Mm Drill Bit 1.1Mm 14In Nitinol","code_information":[{"code":"7722464","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4454.0,"discounted_cash":1781.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clamp 4 Hole         7106-7375","code_information":[{"code":"7722465","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1892.0,"discounted_cash":756.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Twinfix 5Mm Preload Flat Inserter Nonabsorbable W/2-#2 Uhmwpe Ultrabraid Needle","code_information":[{"code":"7722466","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire #2 38In 1/2 Circ Dbl Pig Taper Point Blue White Black Ar-7201 Arthro Braid Uhmwpe","code_information":[{"code":"7722467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Extern Fixat Lg W/Ankle Frame Mri-Safe Strl","code_information":[{"code":"7722468","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":13422.0,"discounted_cash":5368.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bentson .035       G14590 Ptfe Wire","code_information":[{"code":"7722469","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Urological 0.038Inx145Cm 8Cm Amplatz Strt Fixed Core Flex Dbl Tip Ss Mri-Unsafe","code_information":[{"code":"7722470","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hiwire Nitinol .038     G30473","code_information":[{"code":"7722471","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Mini Profile   At2-M1813 Acutrak-2 Mini Profile Drill","code_information":[{"code":"7722472","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":340.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X20Mm Non-Locking Full Thread Self-Tap Cortic Timax Color-Cd Tibial Coarse","code_information":[{"code":"7722473","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire #2 38In 1/2 Circ T-5 Taper Point Blue Ar-7200 Arthro Braid Uhmwpe 26.5Mm W/Needle","code_information":[{"code":"7722474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Independence Sm 30X13X24Mm 8Deg Lordot","code_information":[{"code":"7722475","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":36595.0,"discounted_cash":14638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X420Mm 130Deg Angle Cannul Lck Antegrad Lt Femur Trochan Ti Alloy Lime","code_information":[{"code":"7722476","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7041.0,"discounted_cash":2816.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 135Mm 6-Hole Pre-Contoured Low Bend Compress Lck Ss Lt Dist Medial Tibial Ns","code_information":[{"code":"7722477","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4901.0,"discounted_cash":1960.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 66Mm 7-Hole Strt Compress Lck Lo-Pro Ss Reconstruct Condylar Ankle F/2.7Mm Screw Mini","code_information":[{"code":"7722478","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2230.0,"discounted_cash":892.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 1.6Mm 150Mm Thread Drill Tip Cobalt Ss F/3.5/4Mm Cannul Screw Ns","code_information":[{"code":"7722479","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X42Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7722480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":164.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Laser Fiber Holmium     G48526 Single Use","code_information":[{"code":"7722481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1187.0,"discounted_cash":474.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sheath Access Ureteral  G19172 Flexor 12Fr X 28Cm","code_information":[{"code":"7722482","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc 0.038Inx145Cm 3Cm Safe-T-J Tip Amplatz Stiff","code_information":[{"code":"7722483","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":54.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hiwire Nitinol .038     G30470","code_information":[{"code":"7722484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extractor Stone Circle  G19110","code_information":[{"code":"7722485","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":227.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral 6Frx24Cm G49905","code_information":[{"code":"7722486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 16X160Mm Cementls Strt Revis Slot Primary Press-Fit Bilat Std Leg Ti Knee","code_information":[{"code":"7722487","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3234.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 74-77Mm/52-54Mm 13Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722488","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 1.5X10Mm Compress Headless 4Mm Thread Self-Drill Ss Ns","code_information":[{"code":"7722489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":371.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 1.5X12Mm Compress Headless 4Mm Thread Self-Drill Ss Ns","code_information":[{"code":"7722490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":371.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 236Mm 9-Hole Compress Lck Ti Rt Dist Femur F/3.5Mm Screw Ns","code_information":[{"code":"7722491","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5578.0,"discounted_cash":2231.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Flower Basket        Fg-V421Pr","code_information":[{"code":"7722492","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5X155/180Mm Maxillofacial 2-Flute Cannul Quick-Coupling Jacobs Chuck End Gold Ss Strl","code_information":[{"code":"7722493","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Plus Max Size 8 14Mm Dist 40Mm Offst 140Mm Cementls Primary Reconstruct Ti","code_information":[{"code":"7722494","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14133.0,"discounted_cash":5653.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Lg 12X10X35Mm Expand Tooth Peek Post Lumb 5Deg Oblique Ns","code_information":[{"code":"7722495","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14420.0,"discounted_cash":5768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Ii 6.5X65Mm Polyaxial Ti Post Pedicle Thoracolum","code_information":[{"code":"7722496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3022.0,"discounted_cash":1208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Drill 4Mm Resorb Poly Strl F/Angular Stable Lck Screw","code_information":[{"code":"7722497","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 9X345Mm Round Cannul Lck Tibial Ti Alloy Dark Blue Strl","code_information":[{"code":"7722498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5001.0,"discounted_cash":2000.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X32Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Brown Femur","code_information":[{"code":"7722499","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X44Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Brown Femur","code_information":[{"code":"7722500","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X46Mm Stable Lck Full Thread Self-Tap Ti T25 Stardrive Recess Angular Brown Femur","code_information":[{"code":"7722501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 4X32Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7722502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Expert 4X38Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7722503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":297.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill 2.9/3.2X150Mm 3-Flute Quick-Coupling Ss Ns F/4Mm Angular Stable Lck Screw","code_information":[{"code":"7722504","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Expert 3.2X330Mm 100Mm Im Tibial 3-Flute Quick-Coupling Cannul Calib Blue Gold Ss Ns","code_information":[{"code":"7722505","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":312.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stent Ureteral 6Frx22Cm G49972 Unversal Soft","code_information":[{"code":"7722506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Wire Ptfe .038    G14731","code_information":[{"code":"7722507","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Access         G18074","code_information":[{"code":"7722508","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X35Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7722509","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":334.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Bone Marrow Aspirat Aspirex Plus Biopsy 8Ga 6In","code_information":[{"code":"7722510","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Putty Bone Graft Accell Evo3 Allograft 5Ml Dbm 3Rd Gen","code_information":[{"code":"7722511","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3996.0,"discounted_cash":1598.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Syringe Tip        04.0015-000 Accell Evo 3  6 Ga X 1.5","code_information":[{"code":"7722512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Bone Marrow    04.0060-200 Aspirex Bone Marrow Kit","code_information":[{"code":"7722513","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Narrow Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7722514","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17549.0,"discounted_cash":7019.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 12X390Mm Round Cannul Lck Tibial Ti Alloy Light Green Strl","code_information":[{"code":"7722515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5001.0,"discounted_cash":2000.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X44Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7722516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":312.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X42Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti T25","code_information":[{"code":"7722517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":312.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Baseplate Tibial Triathlon Size 5 Cement Primary Bead Cocr Peri-Apatite Knee","code_information":[{"code":"7722518","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8682.0,"discounted_cash":3472.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 32Mm 10Mm Asymm X3 Metal W/Peri-Apatite Strl","code_information":[{"code":"7722519","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3178.0,"discounted_cash":1271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire #5 38In 1/2 Circ Taper Convent Cut Blue Ar-7213 Arthro Braid Uhmwpe 48Mm","code_information":[{"code":"7722520","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Tigerwire #2 38In White Black Striped Ar-7203 Arthro Braid Uhmwpe Nonabsorbable Strl","code_information":[{"code":"7722521","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Independence Med 34X11X26Mm 15Deg Lordot","code_information":[{"code":"7722522","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":36595.0,"discounted_cash":14638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Zms 3Mm 100Cm Ball Tip Ss F/Intramedullary Nail Strl","code_information":[{"code":"7722523","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Natural Nail 11.5Mm Long 400Mm 130Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722524","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":153661.0,"discounted_cash":61464.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X105Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7722525","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.0,"discounted_cash":821.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X47.5Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":291.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Natural Nail 3Mm Long 84Mm Thread Tibial Ns","code_information":[{"code":"7722527","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Fixat 3Mm 305Mm Thread Std Guide Cephalomedullary Tibial F/Long/Short Nail Ns","code_information":[{"code":"7722528","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Genesis Ii Size 1 60/42Mm Cement Stemmed Taper Primary Press-Fit Non-Porous Rt Knee","code_information":[{"code":"7722529","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6107.0,"discounted_cash":2442.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 1-2 60-64Mm/42-45Mm 13Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722530","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4103.0,"discounted_cash":1641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.7X50Mm Cannul 18Mm Partial Thread Self-Drilling/Tapping Lo-Pro Cancell Ti Clavicle","code_information":[{"code":"7722531","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Arthro 2.4Mmx12In Non-Threaded Trocar Tip F/6.7Mm Screw Lf Disp","code_information":[{"code":"7722532","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Ortho 1.2Mm 100Mm","code_information":[{"code":"7722533","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Staple Bone Fixat 15X15Mm Compress Ss Ankle Foot","code_information":[{"code":"7722534","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":528.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 1Mm Dbl Pig 150Mm Trocar Tip Disp","code_information":[{"code":"7722535","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":15.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Quickfix 3X32Mm Cannul Partial Thread Self-Tap Lo-Pro Cortic Ti T15 Hexalobe Drive Ankle","code_information":[{"code":"7722536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 2Mm Cervical Cannul Ao Shaft Lf Strl Reus F/Small Bone Fixat","code_information":[{"code":"7722537","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Quickfix 3X36Mm Cannul Partial Thread Self-Tap Lo-Pro Cortic Ti T15 Hexalobe Drive Ankle","code_information":[{"code":"7722538","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Quickfix 3X15Mm Compress Full Thread Self-Drill Cortic Ti T15 Hexalobe Drive Yellow","code_information":[{"code":"7722539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Pin Drill Trim-It Arthro 1.5X100Mm Shoulder Cannul Absorb Metal Zip Lf Plla F/Implant Delivery","code_information":[{"code":"7722540","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Zuk Size A Unicompart High Flexion Zimaloy Rt Medial Lt Lat Knee","code_information":[{"code":"7722541","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11141.0,"discounted_cash":4456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/16Mm P/D 90Mm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7722542","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12333.0,"discounted_cash":4933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Aneurx Aaadvantage Stent Covered 15Mm P/D 5.5Cm Strt Woven Iliac Ext Cuff","code_information":[{"code":"7722543","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8225.0,"discounted_cash":3290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 380Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722544","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8511.0,"discounted_cash":3404.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X95Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7722545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.0,"discounted_cash":821.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Pin          2490-046-30 Lag Screw Guide Pin","code_information":[{"code":"7722546","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Pin       00-2490-012-30 Starter Guide Pin","code_information":[{"code":"7722547","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 60Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7722548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7186.0,"discounted_cash":2874.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 147Mm 7-Hole Pre-Contoured Scallop Dynamic Compress Lck Ss Pilon Ant/Lat Dist Tibial","code_information":[{"code":"7722549","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5558.0,"discounted_cash":2223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 380Mm 125Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722550","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8511.0,"discounted_cash":3404.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Voice Rapid Response 20Frx10Mm Silver Oxide Tracheoesophageal Blom-Singer Dual Valve","code_information":[{"code":"7722551","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":436.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Passer Suture Retropasser Arthro Shuttle Point Wire Loop Hndl Nitinol F/Retro Construction","code_information":[{"code":"7722552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Passer Suture Suturelasso Sd Arthro 1.8Mm Sm Shoulder 90Deg Strt Preload Rotator Cuff Stiff Shaft","code_information":[{"code":"7722553","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cannula Arthro Passport Button 1Pc 8Mmx2Cm Lo-Pro Double-Dam Wide Flange W/5Mm Spacer Silicone Lf","code_information":[{"code":"7722554","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Button Suture 12Mm Ti Nonabsorbable Lf Arthro Round 2-Hole Strl","code_information":[{"code":"7722555","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":179.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Wide 12X22X55Mm Expand Tooth Peek Extreme Lat Ns","code_information":[{"code":"7722556","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20313.0,"discounted_cash":8125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coroent Xl-F 5.5X55Mm Var Ang Ti","code_information":[{"code":"7722557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3044.0,"discounted_cash":1217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Instrument Neurosurgical Maxcess 4 Lf Strl Disp","code_information":[{"code":"7722558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5476.0,"discounted_cash":2190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Module Emg Needle Electrode Nvm5 Mercury-Free Disp","code_information":[{"code":"7722559","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3808.0,"discounted_cash":1523.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Dilator Nerve Stimulator Total Spine F/Presurgical Prep Neurovision M5 Xlif Strl Disp","code_information":[{"code":"7722560","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2663.0,"discounted_cash":1065.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Lcp 109Mm 4-Hole Pre-Contoured Low Bend Compress Lck Ss Lt Medial Dist Tibial F/3.5Mm","code_information":[{"code":"7722561","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4708.0,"discounted_cash":1883.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Femur Legion Size 6 Std Univ 5Mm Primary Press-Fit Dist Knee W/Screw On","code_information":[{"code":"7722562","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2875.0,"discounted_cash":1150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Plain Gut 2-0 27In 1/2 Circ Ct-1 Taper Point Yellowish Tan 1 Strand/Pk 843H Uni-Direct","code_information":[{"code":"7722563","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tibial Baseplate      71420162 Sz 2 Genesis Ii Left","code_information":[{"code":"7722564","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8706.0,"discounted_cash":3482.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 70-74Mm/52-54Mm 18Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722565","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3592.0,"discounted_cash":1436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Variax 56Mm 11-Hole 2Mm Short Univ Ti Std Polyaxial Anatomic Lt Dist Volar Radial F/2.7Mm","code_information":[{"code":"7722566","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3021.0,"discounted_cash":1208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.3Mm Ns","code_information":[{"code":"7722567","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc Std Contour Lck Lo-Pro Ti Rt Volar Dist Radius Green Ns","code_information":[{"code":"7722568","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3246.0,"discounted_cash":1298.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mask Etco2 Sampling Oxymask 1-15Lpm 7Ft Tubing Adult Univ Conn W/Monitoring Adjust Head Strap Clear","code_information":[{"code":"7722569","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Lcp 86Mm 2-Hole Pre-Contoured Compress Lck Ss Lt Olecranon F/3.5Mm Screw Ns","code_information":[{"code":"7722570","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3002.0,"discounted_cash":1200.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 9Mm Artic Surface Post Stabil Bearing Uhmwpe Strl","code_information":[{"code":"7722571","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4509.0,"discounted_cash":1803.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 4 Cement Post Stabil Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7722572","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8932.0,"discounted_cash":3572.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Passer Suture Suturelasso Arthro 1.25Mm Micro 6In Glenoid Labral Minor Bend Sm Curve Preload","code_information":[{"code":"7722573","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 9 52X165Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7722574","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12143.0,"discounted_cash":4857.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Applier Clip Ligaclip Endo Multi 12Mmx13.4In Ligat Rotat Shaft Endpoint Ti Lf Strl Disp F/20-Large","code_information":[{"code":"7722575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Natural Nail 11.5Mm Long 360Mm 125Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722576","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X90Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7722577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Va-Lcp 63Mm 6/4-Hole Narrow Compress Lck Ss 2-Column Var Ang Lt Dist Volar Radial F/2.4Mm","code_information":[{"code":"7722578","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":1442.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X12Mm Cannul Compress Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round","code_information":[{"code":"7722579","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X18Mm Cannul Compress Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round","code_information":[{"code":"7722580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X22Mm Cannul Compress Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Ns","code_information":[{"code":"7722581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X10Mm Cannul Compress Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round","code_information":[{"code":"7722582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X14Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Dist Radial","code_information":[{"code":"7722583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X75Mm Cannul Compress Lck Partial Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7722584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":252.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 5X80Mm Cannul Compress Lck Partial Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7722585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":252.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Electrosurgical Cautery 2.5In Tip Blade Modif Insul Extend Ptfe Coat Ltx","code_information":[{"code":"7722586","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 5X55Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss Hex","code_information":[{"code":"7722587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":286.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Resectoscopic Shark S-Line Bipol 0.3Mm 12-30Deg Round Loop Cut Blue Fork Stem Strl Disp","code_information":[{"code":"7722589","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode H 24.5 Fr   46300223 Donut Head Sterile Single Use","code_information":[{"code":"7722590","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode 22 Fr      4623.0243 Coagulating Vaporizing Steril","code_information":[{"code":"7722591","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Legion Size 3-4 9Mm Artic Surface Post Stabil High Flexion Xlpe Strl","code_information":[{"code":"7722592","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 6 Narrow Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7722593","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17039.0,"discounted_cash":6815.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 74-77Mm/52-54Mm 15Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722594","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Tendril Sts Bipol 6Frx10Mm Space 46/52/58Cm Atrial Is-I Conn Silicone","code_information":[{"code":"7722595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2731.0,"discounted_cash":1092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Cps Aim Sl Inner 7Fr Univ 59Cm 135Deg Sub Acute Slittable Quartet Soft Atraum Tip","code_information":[{"code":"7722596","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Cps Direct Sl Ii Outer 7/2X9/3Frx50.7Cm Wide Curve 47Cm Slittable W/Dilator 2-Valve","code_information":[{"code":"7722597","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Slitter Pacemaker Cps Aim Sl Univ 4Fr","code_information":[{"code":"7722598","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":39.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Liss 316Mm 13-Hole Contour Compress Lck Ti Fixed Angle Limit-Cont Rt Dist Femur F/5Mm","code_information":[{"code":"7722599","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6043.0,"discounted_cash":2417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Expert 9X150Mm Round Cannul Lck Antegrad Prox Humeral Ti Alloy Blue Strl","code_information":[{"code":"7722600","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6621.0,"discounted_cash":2648.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 4X30Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Ns","code_information":[{"code":"7722601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Expert 2X240Mm Kirschner Temp Trocar Tip Spade Ss W/Guide Ns F/Humeral Instrument Ti","code_information":[{"code":"7722602","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Expert 4.5X165Mm Im Tibial Cannul Jacobs Chuck End Calib W/135Mm Stop Ti Ns","code_information":[{"code":"7722603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Expert Cannul T25 Stardrive Recess 0Mm Ext Lck Protect Ti Humeral Gold F/Nail Ns","code_information":[{"code":"7722604","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 2 44X130Mm Cement High Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7722605","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12139.0,"discounted_cash":4855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 14X8X12Mm Thoracolum Ant Cervical 0Deg","code_information":[{"code":"7722606","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13457.0,"discounted_cash":5382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Std 24Mm","code_information":[{"code":"7722607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":644.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Std 26Mm","code_information":[{"code":"7722608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":644.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Cement Constrain Revis Oxinium Rt Knee","code_information":[{"code":"7722609","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20395.0,"discounted_cash":8158.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Femur Legion Size 5 Std Univ 5Mm Primary Press-Fit Dist Knee W/Screw On","code_information":[{"code":"7722610","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3783.0,"discounted_cash":1513.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 1-2 60-64Mm/42-45Mm 18Mm Lt Rt Artic Surface Constrain Xlpe","code_information":[{"code":"7722611","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6424.0,"discounted_cash":2569.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 2 Cement Stemmed Taper Revis Ti Porous Rt Knee Strl","code_information":[{"code":"7722612","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8845.0,"discounted_cash":3538.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Pin Bone Fixat 0.062X70Mm Lo-Pro Perm Tension Band Ss Strl","code_information":[{"code":"7722613","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":653.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Comprehensive 11Mm Std 140Mm Cement 45Deg Angle Morse Taper Primary Revers Alignment","code_information":[{"code":"7722614","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12996.0,"discounted_cash":5198.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Bio-Modular 44Mm Offst 17Mm Cocr","code_information":[{"code":"7722615","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5052.0,"discounted_cash":2020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +8.5Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7722616","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2936.0,"discounted_cash":1174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Trilogy 6.5X40Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cortic Strl","code_information":[{"code":"7722617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Trilogy 36X56Mm Std 7.9Mm Neutral 0Deg Angle Full Hemis Primary Modul Longevity Xl","code_information":[{"code":"7722618","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5336.0,"discounted_cash":2134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular 56Mm Multi-Hole Hemis Primary Revis Modul Solid Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7722619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10555.0,"discounted_cash":4222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Proc Durasphere Exp 20Ga 15In Pencil Point Tip","code_information":[{"code":"7722620","type":"CDM"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.2X117Mm 9-Hole 2.7Mm Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic","code_information":[{"code":"7722621","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1524.0,"discounted_cash":609.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 10.2X104Mm 8-Hole 2.7Mm Strt Dynamic Compress Lck Lo-Pro Ss Reconstruct Pelvic","code_information":[{"code":"7722622","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1484.0,"discounted_cash":593.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5Mm Long 230Mm 200Mm Hand Maxillofacial 3-Flute Quick-Coupling Calib Ss Ns F/Lcp Modul","code_information":[{"code":"7722623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X34Mm Compress Lck Self-Tap Var Ang Lo-Pro Cortic Ss T15 Stardrive Recess Hex Head","code_information":[{"code":"7722624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X40Mm Compress Lck Self-Tap Var Ang Lo-Pro Cortic Ss T15 Stardrive Recess Hex Head","code_information":[{"code":"7722625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X60Mm Compress Lck Self-Tap Var Ang Lo-Pro Cortic Ss T15 Stardrive Recess Hex Head","code_information":[{"code":"7722626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X90Mm Compress Lck Self-Tap Var Ang Lo-Pro Cortic Ss T15 Stardrive Recess Hex Head","code_information":[{"code":"7722627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X22Mm Compress Lck Self-Tap Var Ang Lo-Pro Cortic Ss T15 Stardrive Recess Hex Head","code_information":[{"code":"7722628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Cps Direct Sl Ii Outer 7/2X9/3Frx50.7Cm 135Deg Angle Curve 47Cm Slittable W/Dilator","code_information":[{"code":"7722629","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Cps Direct Sl Ii Outer 7/2X9/3Frx50.7Cm 115Deg Curve 47Cm Slittable W/Dilator","code_information":[{"code":"7722630","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Cps Direct Sl Ii Extra-Wide Outer 7/2X9/3Frx50.7Cm Curve 47Cm Slittable W/Dilator","code_information":[{"code":"7722631","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Monocryl 3-0 27In Strt Ks Revers Cut Undyed 1 Strand/Pk Y523H Uni-Direct Monofil","code_information":[{"code":"7722632","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless Optical Xl 12X100Mm Z-Threaded Sleeve Lf Abdomin","code_information":[{"code":"7722633","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Lap Kii Cann 12X100Mm Z-Threaded W/Seal Lf Strl Abdomin Access","code_information":[{"code":"7722634","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless Optical Xl 5X100Mm Z-Threaded Sleeve Lf Abdomin","code_information":[{"code":"7722635","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Introducer Cath Venatech Lp Hemostat Vlv Brachial W/7Fr Sheath Dilator 0.035In Gw Vena Cava","code_information":[{"code":"7722636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Filter Vasc Venatech Lp Conical Lo-Pro Slf-Expand Hemost Vlv Embolic Ivc Vena Cava W/9Fr 7Fr","code_information":[{"code":"7722637","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4161.0,"discounted_cash":1664.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Peel-Away 6Fr Lg 15.5Cm Coaxial 2-Knob W/20Cm Vessel Dil 0.035In Gw","code_information":[{"code":"7722638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Legion Size 7-8 9Mm Artic Surface Post Stabil High Flexion Xlpe Strl","code_information":[{"code":"7722639","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5433.0,"discounted_cash":2173.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel 12.8Cm 5.1Cm Hp 450Ml Silicone Gel Smooth Ant Diaphragm Vlv Slf-Seal Round","code_information":[{"code":"7722640","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2873.0,"discounted_cash":1149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Hp 475Ml Silicone Gel Smooth Round","code_information":[{"code":"7722641","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2873.0,"discounted_cash":1149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Breast Implant 500Cc  350-5004","code_information":[{"code":"7722642","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2873.0,"discounted_cash":1149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 13.6Cm 5.5Cm Hp 550Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7722643","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2873.0,"discounted_cash":1149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 14Cm 5.6Cm Hp 600Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7722645","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2873.0,"discounted_cash":1149.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 360Mm 130Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722650","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 400Mm 130Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722651","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X115Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7722652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Bit          2490-075-43","code_information":[{"code":"7722653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X40Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 3-4 68-71Mm/48-50Mm 15Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722655","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Gh/7-10 12Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7722656","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5962.0,"discounted_cash":2384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 10Mm Univ 360Mm Tibial Ti Alloy","code_information":[{"code":"7722657","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5688.0,"discounted_cash":2275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X70Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Cort 3.5X52.5                    47248405250","code_information":[{"code":"7722659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Natural Nail 0Mm Ext Ti Tibial","code_information":[{"code":"7722660","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Cort 3.5X35  47248403550","code_information":[{"code":"7722661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X27.5Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Natural Nail 4.3Mm Long Tibial Humeral Antegrad Calib Ss Ns","code_information":[{"code":"7722663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Natural Nail 4.3Mm Short Dist Targeting Freehand Ss Ns","code_information":[{"code":"7722664","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 34/16Mm P/D 170Mm Bifurc Woven Aortic Ext Cuff Slf-Expand","code_information":[{"code":"7722665","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29782.0,"discounted_cash":11912.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 14/22Mm P/D 120Cm Woven Iliac Ext Cuff Slf-Expand Xcelerant","code_information":[{"code":"7722666","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14040.0,"discounted_cash":5616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Med 34X17X26Mm 8Deg Lordot","code_information":[{"code":"7722667","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35529.0,"discounted_cash":14211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Med 34X13X26Mm 8Deg Lordot","code_information":[{"code":"7722668","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35529.0,"discounted_cash":14211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Biliary Express Ld 6X17Mm 75Cm Cath 6X20Mm Bln Otw Bln-Expand Pre-Mount Ss Iliac Artery","code_information":[{"code":"7722669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":5076.0,"discounted_cash":2030.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Hurricane Dilatat Endo 5.8Frx180Cm 8Mmx4Cm Rx Lo-Pro Semi-Compli Ss Stylet Disp 0.35In","code_information":[{"code":"7722670","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":291.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Hurricane Dilatat Endo 5.8Frx180Cm 10Mmx4Cm Rx Lo-Pro Semi-Compli Ss Stylet Disp 0.35In","code_information":[{"code":"7722671","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":291.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Summit Size 1 36X125Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7722672","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12143.0,"discounted_cash":4857.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 7-8 81-85Mm/56-59Mm 13Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722673","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 6 Narrow Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7722674","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17039.0,"discounted_cash":6815.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 4 Narrow Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7722675","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17039.0,"discounted_cash":6815.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 1-2 60-64Mm/42-45Mm 11Mm Lt Rt Artic Surface Post Stabil Xlpe","code_information":[{"code":"7722676","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5602.0,"discounted_cash":2240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Nexgen 38Mm Std 9.5Mm Onset All Pe Strl","code_information":[{"code":"7722677","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2963.0,"discounted_cash":1185.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Nexgen Size 7 5Mm Half Block Taper Wedge C/R Tivanium Pmma Precoat Lt Rt Knee","code_information":[{"code":"7722678","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3329.0,"discounted_cash":1331.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shears Ultrasonic Harmonic Ace +7 Lap Scalpel 5Mm Xlong 45Cm Bariatric Abdomin Curve Blunt Taper Tip","code_information":[{"code":"7722679","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1742.0,"discounted_cash":696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stapler Inter Echelon 3000 Lap Long 60Mm 44Cm Sgl-Hand Articulat Power 12-Firing","code_information":[{"code":"7722680","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":368.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reload Staple Echelon Endopath Gst Endo Linear Cutter 60Mm 4.1/2Mm Open/Closed Thk Tissue 6-Row","code_information":[{"code":"7722681","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Valve Suction/Irrigat F/Flexible Intubat Video Endoscope Strl Disp","code_information":[{"code":"7722682","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Meniscal Cinch 1.5X5Mm Curve Tip Sgl-Hand Lo-Pro Pistol Grip Hndl W/2-0 Petrified","code_information":[{"code":"7722683","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":507.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Grip Cable Dall-Miles Med Vitallium Trochan W/2Mm 2-Cable Strl","code_information":[{"code":"7722684","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3595.0,"discounted_cash":1438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta 13X400Mm Cannul Lck Retrograd Multi-Planar Dist Femur Ti Alloy Gold Strl","code_information":[{"code":"7722685","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6494.0,"discounted_cash":2597.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tip Cover Bougie       1465-40","code_information":[{"code":"7722686","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 62Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7722687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6528.0,"discounted_cash":2611.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Fios Bladeless Optical 12X130Mm Bln Gel Port Blunt Tip Lf Strl Abdomin Access","code_information":[{"code":"7722688","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Versys 17X160Mm Primary Offst Collar Midcoat Tivanium Porous Fiber Metal Strt Std Body","code_information":[{"code":"7722689","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18934.0,"discounted_cash":7573.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 54Mm Unipol 12/14 Taper Primary Endoprosthesis Zimaloy Hip Strl","code_information":[{"code":"7722690","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1917.0,"discounted_cash":766.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Tibial Nexgen Size 9 89/53Mm Stemmed C/R Tivanium Pmma Uhmwpe Precoat Lt Rt Knee Blue Strl","code_information":[{"code":"7722691","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7411.0,"discounted_cash":2964.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filler Bone Graft Osteosponge 4-10Mm Chips Allograft 2.5Ml Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7722692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Filler Bone Graft Osteosponge 4-10Mm Chips Allograft 10Ml Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7722693","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2949.0,"discounted_cash":1179.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Filler Bone Graft Osteosponge 4-10Mm Chips Allograft 5Ml Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7722694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.0,"discounted_cash":622.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Putty Bone Graft Osteoselect Allograft 2.5Ml Jar Dbm","code_information":[{"code":"7722695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.0,"discounted_cash":496.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Putty Bone Graft Osteoselect Allograft 5Ml Jar Dbm","code_information":[{"code":"7722696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Putty Bone Graft Osteoselect Allograft 10Ml Jar Dbm","code_information":[{"code":"7722697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.0,"discounted_cash":1440.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Prosthesis Penile Titan Std 10-22Cm Bioflex Silicone Hydrphil Coat Inflate Onetouch Release - D","code_information":[{"code":"7722698","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":559.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reservoir Prosthesis Titan Bioflex Silicone Hydrphil Coat W/75Ml Lockout Vlv Strl","code_information":[{"code":"7722699","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4578.0,"discounted_cash":1831.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Implant Penile Titan Otr 22Cm Bioflex Silicone Inflate Onetouch Release Scrotal W/Cylinder","code_information":[{"code":"7722700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":21297.0,"discounted_cash":8518.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Legion Size 5-6 11Mm Artic Surface Post Stabil High Flexion Xlpe Strl","code_information":[{"code":"7722701","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8761.0,"discounted_cash":3504.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Immobilizer Ortho 2Xl Shoulder Wrist/Humeral Cuff Elastic Chest Strap Hk-Loop Close Cotton Foam Poly","code_information":[{"code":"7722702","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":24.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 54Mm Multi-Hole Bantam Primary Gription W/6.5Mm Dome Screw","code_information":[{"code":"7722703","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6955.0,"discounted_cash":2782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Blade Explant 50Mm  7053-50-20 50Mm Full Explant Blade","code_information":[{"code":"7722704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3260.0,"discounted_cash":1304.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Explant 50Mm  7053-50-10 50Mm Truncated Explant Blade","code_information":[{"code":"7722705","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3260.0,"discounted_cash":1304.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Shaft Bone Graft Matrigraft 60Mm Allograft Frz-Dry Texture Cort/Canc Femur Ambient Store 5Yr Shelf","code_information":[{"code":"7722706","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3005.0,"discounted_cash":1202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 340Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722707","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2X10Mm Cortic Ti Self-Tap Coarse Pitch Gold F/Curvilinear Distract System Cmf","code_information":[{"code":"7722708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Generator Pacemaker Sensia Implant Pulse 2-Chamber","code_information":[{"code":"7722709","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":14518.0,"discounted_cash":5807.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Surgidac 2-0 3-1/2 Met  173021","code_information":[{"code":"7722710","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Polysorb 2-0 Violet 7  170051 18Cm","code_information":[{"code":"7722711","type":"CDM"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Inner Montgomery Safe-T-Tube Long-Term Size 6 33Mm Angle Polish Surface Flange W/2-Plug/Ring","code_information":[{"code":"7722712","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Inner Montgomery Safe-T-Tube Long-Term Size 6 41Mm Angle Polish Surface Flange W/2-Plug/Ring","code_information":[{"code":"7722713","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Trach Montgomery Size 6 W/Ring Set","code_information":[{"code":"7722714","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Elbow Joint 26Mm 4Deg Angle Anatomic Ti Lt Radial F/Arh Solutions 2 System Strl","code_information":[{"code":"7722715","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8130.0,"discounted_cash":3252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Interbody Fusion Coroent Xl 14X18X55Mm Expand Tooth Peek Extreme Lat 10Deg Ns","code_information":[{"code":"7722716","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18149.0,"discounted_cash":7259.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coroent Xl-F 5.5X50Mm Var Ang Ti","code_information":[{"code":"7722717","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3040.0,"discounted_cash":1216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Wide 14X22X60Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7722718","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14957.0,"discounted_cash":5982.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Formagraft 4In J-Shaped Tip F/Aspiration Bone Marrow","code_information":[{"code":"7722719","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Block Bone Graft Formagraft Xl Cahpo4 Hap","code_information":[{"code":"7722720","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5541.0,"discounted_cash":2216.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Alloderm 4X12Cm 1.04-2.28Mm Implant Regen Acell Dermal Matrix F/Ent","code_information":[{"code":"7722721","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4116","type":"HCPCS"}],"standard_charges":[{"gross_charge":5229.0,"discounted_cash":2091.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 32Mm +13Mm Neck 12/14 Taper Modul Cocr Hip","code_information":[{"code":"7722722","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2023.0,"discounted_cash":809.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 2/6-Hole Y-Shaped Compress Lck Lo-Pro Ss Adaption Limit-Cont Extend Condylar F/1.5Mm","code_information":[{"code":"7722723","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1625.0,"discounted_cash":650.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X6Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7722724","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X7Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7722725","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Weight Eyelid Thinprofile Std 1.2Gm Gold Strl","code_information":[{"code":"7722726","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":299.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat 5X40Mm 80Cm Rx Semi-Compli F/Pta 2-Longitudinal Wire","code_information":[{"code":"7722727","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.0,"discounted_cash":931.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Sm 30X11X24Mm 8Deg Lordot","code_information":[{"code":"7722728","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35522.0,"discounted_cash":14208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Lg 39X17X29Mm 8Deg Lordot","code_information":[{"code":"7722729","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35522.0,"discounted_cash":14208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Va-Lcp 72Mm 6/5-Hole Narrow Compress Lck Ss 2-Column Var Ang Lt Dist Volar Radial F/2.4Mm","code_information":[{"code":"7722730","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3738.0,"discounted_cash":1495.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X12Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Dist Radial","code_information":[{"code":"7722731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X20Mm Cannul Compress Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Ns","code_information":[{"code":"7722732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 5X17Mm 80Cmx20Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7722733","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 5Mm Short Shaft 12Mm 80Cmx15Mm Bln Bln-Expand Mount Ss Common","code_information":[{"code":"7722734","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 6X27Mm 80Cmx30Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7722735","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 6X17Mm 80Cmx20Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7722736","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 10X57Mm 80Cmx60Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7722737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 7X20Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7722738","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 10X20Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7722739","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X20Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7722740","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 12X20Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7722741","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X20Mm 80Cm Otw Semi-Compli 2Lumen F/Pta Ultra","code_information":[{"code":"7722742","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Sealant Hemostat Human Fibrinogen Thrombin Fibrin Vistaseal Adjunctive","code_information":[{"code":"7722743","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":623.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Applicator Vistaseal Dual Rigid Tip Tissue Glue 35Cm Adjunctive","code_information":[{"code":"7722744","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 52Mm Multi-Hole Bantam Primary Gription W/6.5Mm Dome Screw","code_information":[{"code":"7722745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6955.0,"discounted_cash":2782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Aml 15X43X155Mm Cementls Std Offst Collar Sm Stature Ti Full Porocoat 135Deg Angle 12/14","code_information":[{"code":"7722746","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12773.0,"discounted_cash":5109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 8.5Mmx38Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gray Strl","code_information":[{"code":"7722747","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6137.0,"discounted_cash":2454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.5X45Mm Lck Inter Captured Cortic Ti Hex Head Gray Im F/8.5Mm","code_information":[{"code":"7722748","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Gore Propaten 8Mmx40Cm Thin-Wall Sgl Motor Eptfe Heparin Coat Lf Strl Disp","code_information":[{"code":"7722749","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3671.0,"discounted_cash":1468.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Gore Propaten 8Mmx80Cm Thin-Wall Sgl Motor Eptfe Heparin Coat Lf Strl Disp","code_information":[{"code":"7722750","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":7055.0,"discounted_cash":2822.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Forceps Spec Retriev Endojaw Alligator Biopsy 5Mm Open 155Cm Upper Gi W/Needle Gray Sheath Ss Strl","code_information":[{"code":"7722751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cannula Inner Montgomery Safe-T-Tube Long-Term Size 8 33Mm Angle Polish Surface Flange W/2-Plug/Ring","code_information":[{"code":"7722752","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cannula Inner Montgomery Safe-T-Tube Long-Term Size 8 41Mm Angle Polish Surface Flange W/2-Plug/Ring","code_information":[{"code":"7722753","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Trach Montgomery Size 8 Ring Silicone Strl F/Secondary Airway","code_information":[{"code":"7722754","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Comprehensive 9Mm Std 122Mm Cement 45Deg Angle Morse Taper Primary Revers Alignment","code_information":[{"code":"7722755","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12996.0,"discounted_cash":5198.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Bio-Modular 4X54Mm Offst 22Mm Cocr","code_information":[{"code":"7722756","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5052.0,"discounted_cash":2020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Formagraft Lg 4X15X45Mm Void B-Tcp Ha Bovine Tendon Type I Collagen","code_information":[{"code":"7722757","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4352.0,"discounted_cash":1740.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Ii 6.5X30Mm Polyaxial Ti Post Pedicle Thoracolum","code_information":[{"code":"7722758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1173.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X55Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7722759","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2098.0,"discounted_cash":839.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Bone Impacted Narrow","code_information":[{"code":"7722760","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9919.0,"discounted_cash":3967.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Lg 10X10X25Mm Expand Tooth Peek Post Lumb 5Deg Oblique Ns","code_information":[{"code":"7722761","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14001.0,"discounted_cash":5600.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Connector Spinal Spherx Ii 50-60Mm Transverse Variable Ti","code_information":[{"code":"7722762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4640.0,"discounted_cash":1856.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shaft Screwdriver Stardrive Hex Cannul Ns F/4Mm Screw","code_information":[{"code":"7722763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":432.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular 50Mm Multi-Hole Hemis Primary Revis Modul Solid Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7722764","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10555.0,"discounted_cash":4222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Kinectiv Size 7.5 114Mm Cementls Modul Ti 132Deg Angle Taper Medial Lat Hip","code_information":[{"code":"7722765","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19415.0,"discounted_cash":7766.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Neck Femur Kinectiv Size J 12/14 Taper Strt Modul Cocr Hip Medial Lat","code_information":[{"code":"7722766","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5360.0,"discounted_cash":2144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 26X50Mm 7.9Mm 20Deg Angle Full Hemis Constrain Modul Lck Ring Longevity Xl","code_information":[{"code":"7722767","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12797.0,"discounted_cash":5118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reservoir Prosthesis Bioflex","code_information":[{"code":"7722768","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4578.0,"discounted_cash":1831.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Implant Penile Titan Otr 18Cm Bioflex Silicone Inflate Onetouch Release Scrotal W/Cylinder","code_information":[{"code":"7722769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":21297.0,"discounted_cash":8518.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Legion Size 5-6 9Mm Artic Surface Post Stabil High Flexion Xlpe Strl","code_information":[{"code":"7722770","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7975.0,"discounted_cash":3190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Va-Lcp 24Mm Xs X-Shaped Compress Lck Ss Var Ang Fore/Midfoot F/2.4/2.7Mm Screw Ns","code_information":[{"code":"7722771","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3260.0,"discounted_cash":1304.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X10Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7722772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X18Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7722773","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X20Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7722774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X22Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7722775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.4X16Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Dist Radial","code_information":[{"code":"7722776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Lcp 1.6X150Mm Compress Temp 10Mm Thread Ss Ns","code_information":[{"code":"7722777","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X18Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Wrist Hand","code_information":[{"code":"7722778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":83.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Strap Distractor Guhl Ankle Foot Belt Position 5-Hole Lf Mri-Cond Strl Disp F/Ferkel Thigh System","code_information":[{"code":"7722779","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Distractor Surg 14Mm Ankle Ti","code_information":[{"code":"7722780","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Summit Size 9 44X165Mm Cementls Std Offst Collarls Cocr Porocoat 130Deg Angle 12/14 Taper","code_information":[{"code":"7722781","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12143.0,"discounted_cash":4857.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Shaver Xps Skimmer Endo 2.9Mmx11Cm Sinus Inferior Turbinate 360Deg Strt Angle Tip Shaft","code_information":[{"code":"7722782","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.5X25Mm Lck Inter Captured Cortic Ti Hex Head Gray Im F/8.5Mm","code_information":[{"code":"7722783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 8.5Mmx34Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gray Strl","code_information":[{"code":"7722784","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6137.0,"discounted_cash":2454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Humeral 11X130Mm 48Deg Angle Trabecul Metal","code_information":[{"code":"7722785","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13578.0,"discounted_cash":5431.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial S-Rom Noiles Size 4 74.9/49.3Mm 15Mm Cement Post Stabil Tricompart Revis","code_information":[{"code":"7722786","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17823.0,"discounted_cash":7129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext S-Rom Noiles 16Mm Univ 75Mm Cement Modul Flute Rotat Hinge Cocr Knee Strl","code_information":[{"code":"7722787","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6661.0,"discounted_cash":2664.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Tibial Mbt Lcs Complete 45Mm 40Mm Metaphyseal Knee Modul Revis Tray Pe Porous F/Lps","code_information":[{"code":"7722788","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6612.0,"discounted_cash":2644.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Caliber-L 10X26Mm X 8-12Mm Optimiz Fit Expand Ti Lat Lumb 4Deg Lordot","code_information":[{"code":"7722789","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30506.0,"discounted_cash":12202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Caliber-L 10X26Mm X 10-15Mm Optimiz Fit Expand Ti Lat Lumb 4Deg Lordot","code_information":[{"code":"7722790","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12054.0,"discounted_cash":4821.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tissue Filter        Atec Tf-1","code_information":[{"code":"7722791","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 10Mm Long 340Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722792","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X110Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7722793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X37.5Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X45Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Block Bone Graft Osteosponge 10X10X10Mm Allograft Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7722796","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":808.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Osteowrap 10X15Mm Cortic Dbm Upper Extrem Foot Ankle Hip Spinal Cmf F/Plastic","code_information":[{"code":"7722797","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":547.0,"discounted_cash":218.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Osteowrap 15X15Mm Cortic Dbm Upper Extrem Foot Ankle Hip Spinal Cmf F/Plastic","code_information":[{"code":"7722798","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Punch Arthro Scorpion Surefire F/5.5Mm Corkscrew Ft 4.75/5.5Mm Swivelock Anchor Lf Disp","code_information":[{"code":"7722799","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Corkscrew Ft 5.5X14.7Mm Full Thread Eyelet Bioabsorbable W/2-#2 Fiberwire Peek Strl","code_information":[{"code":"7722800","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":507.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Handpiece Breast Biopsy Celero 12Ga W/Vacuum Assist Spring Load","code_information":[{"code":"7722801","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Marker Breast Biopsy Smark-Celero-12 Secure Site Identifier Ti","code_information":[{"code":"7722802","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Allograft Bone Osteowrap Med 20X20Mm Cortic Dbm Upper Extrem Foot Ankle Hip Spinal Cmf F/Plastic","code_information":[{"code":"7722803","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Osteowrap Lg 30X30Mm Cortic Dbm Upper Extrem Foot Ankle Hip Spinal Cmf F/Plastic","code_information":[{"code":"7722804","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3695.0,"discounted_cash":1478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Osteowrap Xl 25X50Mm Cortic Dbm Upper Extrem Foot Ankle Hip Spinal Cmf F/Plastic","code_information":[{"code":"7722805","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4905.0,"discounted_cash":1962.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 28/16Mm P/D 166Mm Bifurc Freeflo Closed Web Iliac","code_information":[{"code":"7722806","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30946.0,"discounted_cash":12378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 16Mm P/D 93Mm Bifurc Open-Closed Web Contralateral","code_information":[{"code":"7722807","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14429.0,"discounted_cash":5771.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 16/13Mm P/D 124Mm Bifurc Preload Slf-Expand","code_information":[{"code":"7722808","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15436.0,"discounted_cash":6174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Independence Med 34X11X26Mm 8Deg Lordot","code_information":[{"code":"7722809","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35529.0,"discounted_cash":14211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Gender Solutions Nexgen Lps-Flex Size F Post Stabil Specific Zimaloy Pmma Lt Strl","code_information":[{"code":"7722810","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17612.0,"discounted_cash":7044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sphere Emboliz Embosphere Syringe","code_information":[{"code":"7722811","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Microcatheter 135Cm     Ecp135 Embo Cath Plus 135Cm X 40 Cm","code_information":[{"code":"7722812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1136.0,"discounted_cash":454.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Angled Tip   Tnr2811 .018 In X 46Mm Dia / Specials","code_information":[{"code":"7722813","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":293.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Va-Lcp 58Mm 6/3-Hole Narrow Compress Lck Ss 2-Column Var Ang Rt Dist Volar Radial F/2.4Mm","code_information":[{"code":"7722814","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3474.0,"discounted_cash":1389.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X16Mm Cannul Compress Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round","code_information":[{"code":"7722815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Lcp 1.8X150Mm Kirschner Temp Depth Marker Trocar Point Ss Ns F/2.4Mm Screw","code_information":[{"code":"7722816","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 4 Cement Constrain Revis Oxinium Rt Knee","code_information":[{"code":"7722817","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15357.0,"discounted_cash":6142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Femur Legion Size 4 5Mm 5Mm L-Shaped Revis Knee W/Screw On","code_information":[{"code":"7722818","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3232.0,"discounted_cash":1292.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 1 Cement Stemmed Taper Revis Ti Porous Rt Knee Strl","code_information":[{"code":"7722819","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6719.0,"discounted_cash":2687.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext Legion 13X120Mm Cementls Strt Revis Slot Primary Press-Fit Bilat Std Leg Ti Knee","code_information":[{"code":"7722820","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3099.0,"discounted_cash":1239.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Genesis Ii Size 1-2 10Mm Compo Full Step Wedge Revis Knee W/Screw On","code_information":[{"code":"7722821","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3837.0,"discounted_cash":1534.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Prolong Size Cd 14Mm Artic Surface","code_information":[{"code":"7722822","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5962.0,"discounted_cash":2384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stapler Inter Echelon 3000 Lap Long 45Mm 44Cm Sgl-Hand Articulat Power 12-Firing","code_information":[{"code":"7722823","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":440.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reload Staple Echelon Endopath Gst Endo Linear Cutter 45Mm 2.6/1Mm Open/Closed Vasc Thin Tissue","code_information":[{"code":"7722824","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reload Staple Echelon Endopath Gst Endo Linear Cutter 45Mm 3.6/1.5Mm Open/Closed Reg Tissue 6-Row","code_information":[{"code":"7722825","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Reload Staple Echelon Endopath Gst Endo Linear Cutter 45Mm 4.1/2Mm Open/Closed Reg Thk Tissue 6-Row","code_information":[{"code":"7722826","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versanail 3.5X36Mm Non-Locking Full Thread Solid Cortic Hex Prox Humeral F/8Mm Nail 2.9Mm","code_information":[{"code":"7722827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reamer Surg Versanail Entry 11.5Mm Ns","code_information":[{"code":"7722828","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":347.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X55Mm Bipol Modul Cup Ball Cocr Hip Blue","code_information":[{"code":"7722829","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":923.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Laryngeal Transoral Prolaryn Plus","code_information":[{"code":"7722830","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":624.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Trans-Oral       9010M0 For Radiesse Voice","code_information":[{"code":"7722831","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":83.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Siltex 14.6X12.6Cm 7.6Cm Contour-Profile 650Ml Silicone Gel Texture Bufferzone","code_information":[{"code":"7722832","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4811.0,"discounted_cash":1924.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sizer Breast Implant 15X12.7Cm 6.6Cm Contour Hp 650Ml Saline-Filled Smooth 2-Way Check Slf-Seal","code_information":[{"code":"7722833","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Ethibond Excel #0 30In 1/2 Circ Ct-2 Taper Point Green 1 Strand/Pk X412H Uni-Direct","code_information":[{"code":"7722834","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl 2-0 27In 1/2 Circ Sh Taper Point Violet 1 Strand/Pk J317H Uni-Direct Coat Braid","code_information":[{"code":"7722835","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Sofsilk Perma-Hand 4-0 30In 1/2 Circ Sh Taper Point Black 1 Strand/Pk K831H Uni-Direct Wax","code_information":[{"code":"7722836","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 58Mm Multi-Hole Bantam Primary Gription W/6.5Mm Dome Screw","code_information":[{"code":"7722837","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6955.0,"discounted_cash":2782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Femur Asphere 40Mm +12Mm Neck 12/14 Taper Contour M-Specification Metal","code_information":[{"code":"7722838","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12314.0,"discounted_cash":4925.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Putty Bone Graft Equivabone 2.5Ml Moldable Inject Scaffold Dbm Nanocrystal Cahpo4 3-5Min Set","code_information":[{"code":"7722839","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4087.0,"discounted_cash":1634.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Putty Bone Graft Beta-Bsm 10Ml Fast-Set Inject Dbm Nanocrystal Cahpo4 3-5Min Set Time","code_information":[{"code":"7722840","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8665.0,"discounted_cash":3466.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Narrow Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7722841","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17039.0,"discounted_cash":6815.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Standard+ 20Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7722842","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3314.0,"discounted_cash":1325.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Glenoid Fixat Anatomical Shoulder Med 4Mm Pegged Modul Hybrid Uhmwpe","code_information":[{"code":"7722843","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5397.0,"discounted_cash":2158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Comprehensive 14Mm Std 122Mm Cement 45Deg Angle Morse Taper Primary Revers Alignment","code_information":[{"code":"7722844","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12996.0,"discounted_cash":5198.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Glidewire Advantage 0.035Inx260Cm 5Cm Tip Spiral Angle Core Dist Flex Stiff Nitinol","code_information":[{"code":"7722845","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":224.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Natural Nail 11.5Mm Long 340Mm 125Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722846","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X32.5Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10Mmx40Cm Antegrad Lt Femur Lime","code_information":[{"code":"7722848","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6318.0,"discounted_cash":2527.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Transcontinental Xl 18X60X15Mm Self-Distract Peek Lat Lumb 6Deg Lordot","code_information":[{"code":"7722849","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35529.0,"discounted_cash":14211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Implant Penile Titan Otr 14Cm Bioflex Silicone Inflate Onetouch Release Scrotal Narrow","code_information":[{"code":"7722850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":21297.0,"discounted_cash":8518.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Bladeless Optical 5X150Mm Z-Threaded Sleeve Abdomin Access","code_information":[{"code":"7722851","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Dextrus Perm Bipol 6.7Frx53Cm 10Mm Space Rt Atrial Ventric Helical Tip Steroid Elut","code_information":[{"code":"7722852","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X20Mm Non-Locking Lo-Pro Cortic Timax Square Drive Prox Tibial Elbow","code_information":[{"code":"7722853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":95.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X22Mm Non-Locking Lo-Pro Cortic Timax Square Drive Prox Tibial Elbow","code_information":[{"code":"7722854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":95.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 340Mm 130Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722855","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Natural Nail 0Mm Neutral Ti Cephalomedullary","code_information":[{"code":"7722856","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X100Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7722857","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Long Thread 3.0 2490-12-30 3.0 Long Threaded Pin","code_information":[{"code":"7722858","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":162.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin 3.0 Threaded    2490-46-30 3.0 Threaded Pin","code_information":[{"code":"7722859","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 7 Cement Stemmed Taper Revis Ti Porous Lt Knee Strl","code_information":[{"code":"7722860","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6719.0,"discounted_cash":2687.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Legion Size 7-8 5Mm Compo Hemi Step Wedge/Block Revis Lt Medial Rt Lat W/Screw On","code_information":[{"code":"7722861","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3461.0,"discounted_cash":1384.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 7 Cement Constrain Revis Oxinium Lt Knee","code_information":[{"code":"7722862","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15357.0,"discounted_cash":6142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Femur Legion Size 7 10Mm 10Mm L-Shaped Revis Knee W/Screw On","code_information":[{"code":"7722863","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3232.0,"discounted_cash":1292.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Knee Cement Stageone 70Mm Univ Mold Cruciate Sacrificing Agc Silicone Tibial W/Endo Style","code_information":[{"code":"7722864","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3132.0,"discounted_cash":1252.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Knee Cement Stageone 70Mm Univ Mold Cruciate Sacrificing Agc Silicone Femur W/Endo Style Head","code_information":[{"code":"7722865","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cement Bone Cobalt 40Gm/20Ml High Viscos Eto Sterilized Broad-Spect Antibiotic Pmma Gentamicin Blue","code_information":[{"code":"7722866","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1425.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Genesis Ii Size 5-6 74-77Mm/52-54Mm 11Mm Lt Rt Artic Surface Constrain Xlpe Strl","code_information":[{"code":"7722867","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3592.0,"discounted_cash":1436.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lorenz Lactosorb 2X5Mm Ti F/Endobrow Fixat Midface","code_information":[{"code":"7722868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Lactosorb Twist 1.8X60Mm Cmf Notch W/1.75X5Mm Stop","code_information":[{"code":"7722869","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 1.8X5Mm F/Lactosorb System","code_information":[{"code":"7722870","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":182.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size H 81/76Mm Cement Post Stabil Zimaloy Non-Porous Rt Lat Strl","code_information":[{"code":"7722871","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10917.0,"discounted_cash":4366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Natural Nail 3.2Mm Long 508Mm Thread Std Cephalomedullary Ns","code_information":[{"code":"7722872","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":224.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 440Mm 125Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722873","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8049.0,"discounted_cash":3219.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Knee Cement Stageone 65Mm Univ Mold Cruciate Sacrificing Agc Silicone Femur W/Endo Style Head","code_information":[{"code":"7722874","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6606.0,"discounted_cash":2642.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Quickfix 3X18Mm Cannul Partial Thread Self-Tap Lo-Pro Cortic Ti T15 Hexalobe Drive Ankle","code_information":[{"code":"7722875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Band Surg Realize W/Dissector","code_information":[{"code":"7722876","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8764.0,"discounted_cash":3505.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 44Mm Unipol Modul Cathcart Ball Orthocentric Hip F/Fracture","code_information":[{"code":"7722877","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 15 50X145Mm Cementls Collarls High Offst Ti Hap 135Deg Angle Taper 43.2Mm","code_information":[{"code":"7722878","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 27.6X73.8Mm 1.65Mm T-Shaped Pre-Contoured Lck Timax Anatomic F/2.5Mm Screw Ns","code_information":[{"code":"7722879","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1662.0,"discounted_cash":664.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill A.L.P.S 2Mm Mini Qck-Conn Ss Ns Reus F/Hand Frx System Fast Fixat","code_information":[{"code":"7722880","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":68.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho 2.5Mm Thread","code_information":[{"code":"7722881","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X18Mm Screw Lck Perm Round Full Thread Ti Dist Radial Volar F/Hand Frx","code_information":[{"code":"7722882","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X18Mm Screw Non-Locking Perm Full Thread Self-Tap Ti Dist Radial Volar","code_information":[{"code":"7722883","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X12Mm Perm 20Deg Angle Thread Multi-Direct Cocr Cortic Ns Mdt F/Fracture","code_information":[{"code":"7722884","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X20Mm Perm 20Deg Angle Thread Multi-Direct Cocr Cortic Ns Mdt F/Fracture","code_information":[{"code":"7722885","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X22Mm Perm 20Deg Angle Thread Multi-Direct Cocr Cortic Ns Mdt F/Fracture","code_information":[{"code":"7722886","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":166.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Revere 6.5X30Mm Lck Polyaxial Thread Dbl Lead Pedicle Ti Post Thoracolum Top Load","code_information":[{"code":"7722887","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3084.0,"discounted_cash":1233.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Syringe Bone Cement 1Ml Cap Sidept F/Aliquot Delivery System Strl Disp Pre-Packed","code_information":[{"code":"7722888","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Osteovive Plus 1Ml Moldable Rtu Syringe Cortic Fiber Growth Factor Cellular Matrix","code_information":[{"code":"7722889","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9359","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":571.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 28/13Mm P/D 145Mm Bifurc Freeflo Closed Web Iliac","code_information":[{"code":"7722890","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30946.0,"discounted_cash":12378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 16Mm P/D 82Mm Bifurc Open-Closed Web Contralateral","code_information":[{"code":"7722891","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13880.0,"discounted_cash":5552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 28/20Mm P/D 166Mm Bifurc Freeflo Closed Web Iliac","code_information":[{"code":"7722892","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30946.0,"discounted_cash":12378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 16/28Mm P/D 124Mm Bifurc Open-Closed Web Iliac Limb","code_information":[{"code":"7722893","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15436.0,"discounted_cash":6174.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 16/28Mm P/D 93Mm Bifurc Open-Closed Web Iliac Limb","code_information":[{"code":"7722894","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15281.0,"discounted_cash":6112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reload Staple Echelon Endopath Endo Linear Cutter 45Mm 2/0.75Mm Open/Closed Mesenteric Thin Tissue","code_information":[{"code":"7722895","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Vasc Astato 30 Specialty 0.018Inx300Cm 15Cm Strt Tip Taper Balanced Support Spring Coil","code_information":[{"code":"7722896","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Ultraverse 014 Dilatat Workhorse 2.5X120Mm 150Cm Otw Coaxial F/Pta Geoalign","code_information":[{"code":"7722897","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":492.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 9-Hole Wide Pre-Contoured Compress Lck Timax Lt Dist Tibial Ant/Lat Ns","code_information":[{"code":"7722898","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3857.0,"discounted_cash":1542.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 4X48Mm Lck Thread Self-Tap Cancell Timax T15 Stardrive Recess Taper Head Blue","code_information":[{"code":"7722899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Sling Gyn Gynecare Tvt Exact 3Mm Trocar Shaft Platin Stretch-Resistant 2Tip Marker Retropubic","code_information":[{"code":"7722900","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2631","type":"HCPCS"}],"standard_charges":[{"gross_charge":3620.0,"discounted_cash":1448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys 15X160Mm Primary Offst Collar Midcoat Tivanium Porous Fiber Metal Strt Std Body","code_information":[{"code":"7722901","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19310.0,"discounted_cash":7724.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 51Mm Unipol 12/14 Taper Primary Endoprosthesis Zimaloy Hip Strl","code_information":[{"code":"7722902","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1954.0,"discounted_cash":781.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 10Mmx35Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gold Strl","code_information":[{"code":"7722903","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6137.0,"discounted_cash":2454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Trigen 0Mm Ext Ti F/Intramedullary Nail Strl","code_information":[{"code":"7722904","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":258.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Nexgen 26Mm 7.5Mm Onset All Pe Strl","code_information":[{"code":"7722905","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1209.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Nexgen Mis Size 3 Modul Fixed Bearing Stemmed Trabecul Metal Porous Knee","code_information":[{"code":"7722906","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10717.0,"discounted_cash":4286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size D Std 64/57.5Mm Post Stabil Zimaloy Porous Rt Striped Purple","code_information":[{"code":"7722907","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14954.0,"discounted_cash":5981.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Patella 32 X 10 Mm  5878-65-32 Standard Primary Patella","code_information":[{"code":"7722908","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7027.0,"discounted_cash":2810.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reservoir Prosthesis Titan Cl 75Ml Bioflex Silicone Inflate Onetouch Release Self-Contained","code_information":[{"code":"7722909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":5198.0,"discounted_cash":2079.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sealer Bipolar 2.3    23-113-1 Aquamantys 2.3 Bipolar Sealer","code_information":[{"code":"7722910","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1696.0,"discounted_cash":678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sealer Electrosurgical Aquamantys Hemostat Bipol 3.4Mm Tip Lg Rf Endo Dissect Transcollation Malleab","code_information":[{"code":"7722911","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":690.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sealer Electrosurgical Aquamantys Bipol Hemostat 4Mm 172.50X139.45X0.64Mm Space Spinal Epidural Vein","code_information":[{"code":"7722912","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":808.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Rival Dilatat 5Mmx15Cm 135Cm Otw Non-Compli 30-Lumen F/Pta Lo-Pro Nylon","code_information":[{"code":"7722913","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":286.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Introducer Et Tube Bougie Eschemann Stylet 15Frx70Cm Adult Calib Pe Lf Strl Disp","code_information":[{"code":"7722914","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stapler Inter Echelon 3000 Lap Std 45Mm 34Cm Sgl-Hand Articulat Power 12-Firing","code_information":[{"code":"7722915","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":440.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Independence Lg 39X13X29Mm 15Deg Lordot","code_information":[{"code":"7722916","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35529.0,"discounted_cash":14211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Siltex 14X14.6Cm 7.3Cm Contour-Profile 650Ml Silicone Gel Texture Bufferzone","code_information":[{"code":"7722917","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4811.0,"discounted_cash":1924.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 40X62Mm +4 Neutral 10Deg Angle Constrain Pe","code_information":[{"code":"7722918","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11058.0,"discounted_cash":4423.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X20Mm Screw Non-Locking Perm Full Thread Self-Tap Ti Dist Radial Volar","code_information":[{"code":"7722919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Canc 2.5X18Mm      Sp-18","code_information":[{"code":"7722920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Catheter Drain Resolve Specialty 8.5Frx25Cm Pig Taper Flex 8-Drain Hole Lock Manual Release Blue","code_information":[{"code":"7722921","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7722922","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Catheter Drain Resolve Speciality 12Frx25Cm Pig Taper Flex 9-Drain Hole Lock Manual Release","code_information":[{"code":"7722923","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":87.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bone Fixat 1.6Mmx6In Kirschner Temp Steinmann Bayonet Tip Ns F/Orthopedic","code_information":[{"code":"7722924","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X18Mm Cannul Full Thread Reduce Head Cancell Timax Ns","code_information":[{"code":"7722925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guide Pin Long     2490-047-32 3.2 Long Guide Pin","code_information":[{"code":"7722926","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":224.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 76Mm 4-Hole Contour Low Bend Compress Lck Ss Limit-Cont Lt Prox Tibial F/3.5Mm Screw","code_information":[{"code":"7722927","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5258.0,"discounted_cash":2103.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.7X44Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss T15","code_information":[{"code":"7722928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.7X46Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss T15","code_information":[{"code":"7722929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.7X58Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss T15","code_information":[{"code":"7722930","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.7X60Mm Cannul Compress Lck Full Thread Self-Drilling/Tapping Fixed Angle Ss T15","code_information":[{"code":"7722931","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":274.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.7X58Mm Cannul Compress Lck 25Mm Partial Thread Self-Drilling/Tapping Fixed Angle Ss","code_information":[{"code":"7722932","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":240.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint X-Fuse Xl 15Deg Superelastic","code_information":[{"code":"7722933","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3804.0,"discounted_cash":1521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 10Mmx32Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gold Strl","code_information":[{"code":"7722934","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6137.0,"discounted_cash":2454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Plusdrive 2.4X14Mm Emergency Ti Self-Tap Teal Cmf Ns","code_information":[{"code":"7722935","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 50Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7722936","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6528.0,"discounted_cash":2611.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 28X50Mm Neutral Altrx","code_information":[{"code":"7722937","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3549.0,"discounted_cash":1419.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 9 130Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7722938","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 28Mm +1.5Mm Neck 12/14 Taper Modul Biolox Delta Hip","code_information":[{"code":"7722939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4362.0,"discounted_cash":1744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Corail Size 11 145Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7722940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 28Mm +5Mm Neck 12/14 Taper Modul Biolox Delta Hip","code_information":[{"code":"7722941","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4362.0,"discounted_cash":1744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Natural Nail 11.5Mm Long 300Mm 125Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7722942","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X24.5Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7722943","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 4X200Mm 135Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7722944","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 5X200Mm 100Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7722945","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Evercross Dilatat Workhorse 6X200Mm 135Cm Otw Semi-Compli 2Lumen F/Pta","code_information":[{"code":"7722946","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Stent Vascular/Biliary Visi-Pro 8X57Mm 80Cmx60Mm Bln Bln-Expand Mount Ss Common Ext Iliac","code_information":[{"code":"7722947","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Corail Size 12 150Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7722948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 10 140Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7722949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 9X330Mm Round Cannul Lck Tibial Ti Alloy Dark Blue Strl","code_information":[{"code":"7722950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5190.0,"discounted_cash":2076.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Expert 3.2X145Mm Im Tibial 3-Flute Quick-Coupling Cannul Calib Needle Point Green Ti Ns","code_information":[{"code":"7722951","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 4X40Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7722952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 4X42Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7722953","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 4X36Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7722954","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Reamer 2.5X850Mm Humeral Calib Ss Strl","code_information":[{"code":"7722955","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Std 4-4.1X22Mm Cannul Compress Headless Full Wide Thread Self-Tapping/Cutting","code_information":[{"code":"7722956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1693.0,"discounted_cash":677.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Aml 12X40X155Mm Cementls Std Offst Collar Sm Stature Ti Full Porocoat 135Deg Angle 12/14","code_information":[{"code":"7722957","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12773.0,"discounted_cash":5109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 11 125Mm Cementls Lo-Pro Collar Coxa Vara Offst Ti Hap 125Deg Angle 12/14","code_information":[{"code":"7722958","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Scissors Lap Epix Grasp Monopol 5Mmx45Cm Trocar Tip Lo-Pro Dual Edge Sharp Blade Ss Disp","code_information":[{"code":"7722959","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Corail Size 12 130Mm Cementls Lo-Pro Collar Coxa Vara Offst Ti Hap 125Deg Angle 12/14","code_information":[{"code":"7722960","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Ncb 246Mm 9-Hole Lck Ti Protasul-64 Non-Cont Bridge Polyaxial Rt Dist Periprosthetic","code_information":[{"code":"7722961","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4468.0,"discounted_cash":1787.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X44Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7722962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X50Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7722963","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X20Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7722964","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X55Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7722965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X32Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7722966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 13 135Mm Cementls Lo-Pro Collar Coxa Vara Offst Ti Hap 125Deg Angle 12/14","code_information":[{"code":"7722967","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 49X21Mm Narrow Lck Ti Std Lt Dist Volar Radial Ns","code_information":[{"code":"7722968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3710.0,"discounted_cash":1484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Tibial Legion Size 1-2 9Mm Artic Surface Post Stabil High Flexion Xlpe Strl","code_information":[{"code":"7722969","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5433.0,"discounted_cash":2173.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur P.F.C Sigma Tc3 Size 4 71/65Mm Cement Post Stabil C/S Revis Cocr Non-Porous Rt","code_information":[{"code":"7722970","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12603.0,"discounted_cash":5041.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur P.F.C Sigma Cement Bolt 5Deg Angle Revis Ti Knee","code_information":[{"code":"7722971","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9461.0,"discounted_cash":3784.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur P.F.C Sigma +2/-2Mm Offst Cement Bolt 5Deg Angle Revis Ti Knee","code_information":[{"code":"7722972","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":530.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Lcs Complete Univ 34Mm Cntr Ti Full Porous Knee","code_information":[{"code":"7722973","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13354.0,"discounted_cash":5341.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur P.F.C Sigma Size 4 8Mm Wedge/Block Cement Combo Post Knee Strl Disp","code_information":[{"code":"7722974","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2161.0,"discounted_cash":864.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial S-Rom Noiles Size 2.5 67/44Mm 4.8Mm Cement Post Stabil Tricompart Revis Mobile","code_information":[{"code":"7722975","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12029.0,"discounted_cash":4811.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Tibial Mbt Lcs Complete 29Mm 40Mm Metaphyseal Knee Modul Revis Tray Pe Porous F/Lps","code_information":[{"code":"7722976","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6612.0,"discounted_cash":2644.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext S-Rom Noiles 14Mm Univ 75Mm Cement Modul Flute Rotat Hinge Cocr Knee Strl","code_information":[{"code":"7722977","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6661.0,"discounted_cash":2664.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Sigma Tc3 Size 4 76Mm/47Mm 17.5Mm Post Stabil Rotat Platform Uhmwpe","code_information":[{"code":"7722978","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5342.0,"discounted_cash":2136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Extensure H2 14X30Mm Fresh In Saline Cervical","code_information":[{"code":"7722979","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7332.0,"discounted_cash":2932.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Voice Rapid Response 20Frx8Mm Silver Oxide Tracheoesophageal Blom-Singer Dual Valve","code_information":[{"code":"7722980","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":436.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coalition 3.6X12Mm Self-Tap Var Ang Ti Ns","code_information":[{"code":"7722981","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.0,"discounted_cash":721.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Genesis Ii 26Mm 9Mm 3-Peg Resurfac Post Retain Anatomic Uhmwpe","code_information":[{"code":"7722982","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2171.0,"discounted_cash":868.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Coalition Manual 12Mm Angle Self-Centering Sleeve","code_information":[{"code":"7722983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":559.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Dextrus Perm Bipol 6.7Frx45Cm 10Mm Space Rt Atrial Ventric Helical Tip Steroid Elut","code_information":[{"code":"7722984","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Graftjacket 5X5Cm 1.5Mm Regen Max Force Acell Dermal Matrix","code_information":[{"code":"7722985","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8906.0,"discounted_cash":3562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 32X58Mm Neutral 0Deg Angle Marathon","code_information":[{"code":"7722987","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3119.0,"discounted_cash":1247.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Aml 15X52X160Mm Cementls High Offst Collar Lg Stature Ti Full Porocoat 135Deg Angle 12/14","code_information":[{"code":"7722988","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12773.0,"discounted_cash":5109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tamp Directional     2110-0530 6 Inch Directional Tamp","code_information":[{"code":"7722989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2175.0,"discounted_cash":870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 14 160Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7722990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Surg Coalition Manual 12Mm Strt Lf","code_information":[{"code":"7722991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":505.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Fixat 5Mm W/25-Open Absorb Mesh F/Hernia Repair Securestrap Lf Disp","code_information":[{"code":"7722992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1519.0,"discounted_cash":607.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Anchor Suture Implant Delivery W/Ac 18In Nitinol Passing Wire F/Distal Biceps Repair Strl","code_information":[{"code":"7722993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3772.0,"discounted_cash":1508.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 16 150Mm Cementls Lo-Pro Collar Coxa Vara Offst Ti Hap 125Deg Angle 12/14","code_information":[{"code":"7722994","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Add Fx Kit 15/2        Kpe1004","code_information":[{"code":"7722995","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7434.0,"discounted_cash":2973.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Kyphoplasty Kyphopak Additional Frx W/Size 3 15Mm 2-Kyphon Xpander Ibt 6-Bone Filler","code_information":[{"code":"7722996","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7586.0,"discounted_cash":3034.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Curette Surg #2 T-Tip Kyphon Express","code_information":[{"code":"7722997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":615.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 25/16Mm P/D 145Mm Bifurc Freeflo Closed Web Iliac","code_information":[{"code":"7722998","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30946.0,"discounted_cash":12378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc 342Mm 16-Hole Contour Scallop Lck Ss Lt Lat Dist Femur F/4.5Mm Screw","code_information":[{"code":"7722999","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6223.0,"discounted_cash":2489.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Peri-Loc Twist Targeter 3.5Mmx6In Dist Femur Qck-Conn Calib Lf Strl Disp F/Large Frag Lck","code_information":[{"code":"7723000","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Peri-Loc 3.5X40Mm Provision Targeter Lck Ss Periarticular","code_information":[{"code":"7723001","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":249.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Peri-Loc 3.5X18Mm Provision Targeter Lck Ss Periarticular","code_information":[{"code":"7723002","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw 4.5 X 70 Mm    7382-7070","code_information":[{"code":"7723003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X30Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X60Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X40Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X36Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X32Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X34Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723009","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X38Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723010","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X46Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X56Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X42Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7723013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":176.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill A.L.P.S Twist 4X70Mm S-Couple Solid Ns F/Small Frag Frx Plate System","code_information":[{"code":"7723014","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 20Mm P/D 82Mm Bifurc Open-Closed Web Iliac Ext E Delivery","code_information":[{"code":"7723015","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15048.0,"discounted_cash":6019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 16Mm P/D 124Mm Bifurc Open-Closed Web Contralateral","code_information":[{"code":"7723016","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15281.0,"discounted_cash":6112.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 32/20Mm P/D 145Mm Bifurc Freeflo Closed Web Iliac Ext E","code_information":[{"code":"7723017","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30946.0,"discounted_cash":12378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 10.7X79Mm 10-Hole Sm Pre-Contoured Compress Lck Timax Anatomic Fixed Angle","code_information":[{"code":"7723018","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3413.0,"discounted_cash":1365.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 16X9X14Mm 7Deg Lordot","code_information":[{"code":"7723019","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13457.0,"discounted_cash":5382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Natural Nail   747-2493-400-11","code_information":[{"code":"7723020","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Band Inter Fixat 90Mm Tension Strl","code_information":[{"code":"7723021","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1713.0,"discounted_cash":685.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 49X24Mm Narrow Lck Ti Std Lt Dist Volar Radial Ns","code_information":[{"code":"7723022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3710.0,"discounted_cash":1484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Std 4-4.1X24Mm Cannul Compress Headless Full Wide Thread Self-Tapping/Cutting","code_information":[{"code":"7723023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1693.0,"discounted_cash":677.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 18X8X15Mm 7Deg Lordot","code_information":[{"code":"7723024","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13457.0,"discounted_cash":5382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 14 140Mm Cementls Lo-Pro Collar Coxa Vara Offst Ti Hap 125Deg Angle 12/14","code_information":[{"code":"7723025","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 10Mm Long 320Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7723026","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7831.0,"discounted_cash":3132.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X80Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7723027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X85Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7723028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.0,"discounted_cash":755.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 99Mm 5-Hole Pre-Contoured Compress Lck Ss Lt Lat Dist Fibula F/2.7/3.5Mm Screw Ns","code_information":[{"code":"7723029","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":906.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X8Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7723030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Turbohawk Sx Extended Ths-Sx-C Extended Tip Turbohawk","code_information":[{"code":"7723031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":9619.0,"discounted_cash":3847.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Putty Bone Graft Equivabone 5Ml Moldable Inject Scaffold Dbm Nanocrystal Cahpo4 10Min Set Time","code_information":[{"code":"7723032","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6530.0,"discounted_cash":2612.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 16X7X14Mm 7Deg Lordot","code_information":[{"code":"7723033","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13473.0,"discounted_cash":5389.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Guiding Cps Aim Sl Inner 7.62Fr 62X59Cm 90Deg Slittable Integrate Vlv Hydrphil","code_information":[{"code":"7723034","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":404.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Reflexion Lg Phalangeal Base","code_information":[{"code":"7723035","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4239.0,"discounted_cash":1695.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 10 140Mm Cementls Lo-Pro Collarls Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723036","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":6270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hex Head     00590103533 3.5 Mm X 3.2 Dia X 33 Mm Long","code_information":[{"code":"7723037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Pin          00590102000 3.2 Mm Dia 72 Mm Long Trocar","code_information":[{"code":"7723038","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1595.0,"discounted_cash":638.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 3X200Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7723039","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Drain Yueh Centesis 5Frx20Cm Strt 4Sp Pig Loop 5-Lumen W/19Ga Hollow Needle Ss Nylon","code_information":[{"code":"7723040","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Acu-Loc 2 90Mm 5-Hole Contour Lck Lo-Pro Ti Std Rt Olecranon Ns","code_information":[{"code":"7723041","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4024.0,"discounted_cash":1609.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X16Mm Lck Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate System Ns","code_information":[{"code":"7723042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 3.5X18Mm Lck Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate System Ns","code_information":[{"code":"7723043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X22Mm Lck Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate System Ns","code_information":[{"code":"7723044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X16Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 3.5X20Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X22Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3X40Mm Lck Headed Ti Hexalobe Dist Humeral Elbow Wrist F/Total Plate System Ns","code_information":[{"code":"7723048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3X40Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.7X12Mm Lck Cortic Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.7X16Mm Lck Cortic Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.7X18Mm Lck Cortic Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Surgibit 2.8Mm Clavicle Qr Calib","code_information":[{"code":"7723053","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl 10X22X50Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723054","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17107.0,"discounted_cash":6842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 16X6X14Mm 7Deg Lordot","code_information":[{"code":"7723055","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13457.0,"discounted_cash":5382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 9 185Mm Cementls Lo-Pro Collarls Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723056","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":6270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clip Inter Weck Hem-O-Lok Open Endo Nonabsorbable Lg Vessel Tissue Bow Shape Ligat Non-Conductive","code_information":[{"code":"7723057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.69,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Expander Breast Natrelle 13X12Cm 5.6Cm 400Ml Saline-Filled Biocell Texture Magna-Finder Xact Round","code_information":[{"code":"7723058","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":1732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 14X13Cm 6Cm 500Ml Saline-Filled Texture Bio-Dimensional Style 133Mv Mod Hgt","code_information":[{"code":"7723059","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":1732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Biological Tissue Veritas 10X16Cm Bovine Pericardium Collagen Matrix","code_information":[{"code":"7723060","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13901.0,"discounted_cash":5560.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Lg 39X13X29Mm 8Deg Lordot","code_information":[{"code":"7723061","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35529.0,"discounted_cash":14211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Lg 39X11X29Mm 8Deg Lordot","code_information":[{"code":"7723062","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":35529.0,"discounted_cash":14211.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 3/8-Hole T-Shaped Compress Lck Ss Adaption Limit-Cont Extend F/1.5Mm Screw W/Short","code_information":[{"code":"7723063","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":649.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X12Mm Compress Lck Thread Self-Drilling/Tapping Cortic Ss T4 Stardrive Recess Hex","code_information":[{"code":"7723064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 1.5X14Mm Compress Lck Thread Self-Drilling/Tapping Cortic Ss T4 Stardrive Recess Hex","code_information":[{"code":"7723065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 1.5X18Mm Compress Lck Thread Self-Drilling/Tapping Cortic Ss T4 Stardrive Recess Hex","code_information":[{"code":"7723066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X8Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7723067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X10Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7723068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X12Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7723069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X14Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7723070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 10 46.5X140Mm Cementls Collarls High Offst Ti Hap 135Deg Angle Taper 43.2Mm","code_information":[{"code":"7723071","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":6270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 11 145Mm Cementls Lo-Pro Collarls Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723072","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":6270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Statlock Sheath Secure Device                   0684-00-0493","code_information":[{"code":"7723073","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pack Lap Cholecystect","code_information":[{"code":"7723074","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 18X9X15Mm 7Deg Lordot","code_information":[{"code":"7723075","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13457.0,"discounted_cash":5382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Cable Ortho Dall-Miles 1.6Mm Vitallium W/Beaded Sm Sleeve Strl","code_information":[{"code":"7723076","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":993.0,"discounted_cash":397.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Gh/5-6 10Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7723077","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6082.0,"discounted_cash":2432.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X24Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Wrist Hand","code_information":[{"code":"7723078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":83.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 32X56Mm Neutral 0Deg Angle Marathon","code_information":[{"code":"7723079","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2809.0,"discounted_cash":1123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 11X340Mm Cannul Lt Lat Entry Femur Ti Light Green Strl","code_information":[{"code":"7723080","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5681.0,"discounted_cash":2272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X64Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti T25","code_information":[{"code":"7723081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Reamer 3X950Mm Strt Ball Tip Ss Strl","code_information":[{"code":"7723082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":240.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Transcontinental Med 20X50X8Mm Self-Distract Peek Lat Lumb","code_information":[{"code":"7723083","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23268.0,"discounted_cash":9307.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Shim Retractor Mars 3V Disc Alum Strl F/998.901 Set","code_information":[{"code":"7723084","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1990.0,"discounted_cash":796.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Intercontinental 20X8Mm 0Deg Angle Lat Lumb","code_information":[{"code":"7723085","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15513.0,"discounted_cash":6205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Awl Surg Angle W/Sleeve Intercontinental Lf","code_information":[{"code":"7723086","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4604.0,"discounted_cash":1841.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Intercontinental 5.5X45Mm Var Ang Hap Lat Lumb Strl","code_information":[{"code":"7723087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2384.0,"discounted_cash":953.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Intercontinental 5.5X50Mm Var Ang Hap Lat Lumb Strl","code_information":[{"code":"7723088","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2384.0,"discounted_cash":953.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Spectrum Siltex 12.7X11Cm 7.5Cm Contour-Profile 450-540Ml Saline-Filled Texture Post","code_information":[{"code":"7723089","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3804.0,"discounted_cash":1521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X26Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7723091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3X32Mm Cannul Short Thread Self-Drilling/Tapping Cortic Ss Cruciform Recess Head Wrist","code_information":[{"code":"7723092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 12 150Mm Cementls Lo-Pro Collarls Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723093","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":6270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 18X7X15Mm 7Deg Lordot","code_information":[{"code":"7723094","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13457.0,"discounted_cash":5382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl 10X22X55Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723095","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17110.0,"discounted_cash":6844.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl 12X22X55Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723096","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17110.0,"discounted_cash":6844.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Journey Size 4 Unicompart Fixed Bearing Oxinium Rt Medial Lt Lat","code_information":[{"code":"7723097","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15283.0,"discounted_cash":6113.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Journey Size 3 Unicompart Rt Medial Lt Lat","code_information":[{"code":"7723098","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7826.0,"discounted_cash":3130.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Journey Size 3-4 8Mm Rt Medial Lt Lat Artic Surface Unicompart Pe","code_information":[{"code":"7723099","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3851.0,"discounted_cash":1540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 12 48X130Mm Cementls Collarls High Offst Ti Hap 135Deg Angle Taper 43.2Mm","code_information":[{"code":"7723100","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15675.0,"discounted_cash":6270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Reload Suture Endo Stitch Surgidac Auto-Suture Lap Size 0 7In Es-9 Load Unit Green Strl Disp Usp 1.5","code_information":[{"code":"7723101","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":90.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Distractor Affix Ii Caspar Spine F/Corpectomy","code_information":[{"code":"7723102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 360Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Lt","code_information":[{"code":"7723103","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6330.0,"discounted_cash":2532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 11X90Mm Cannul Ti Gold Intertrochan Femur Neck F/Trochanteric Fixat Nail System Strl","code_information":[{"code":"7723104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.0,"discounted_cash":790.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 13X420Mm Cannul Rt Lat Entry Femur Ti Light Green Strl","code_information":[{"code":"7723105","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5681.0,"discounted_cash":2272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X90Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti T25","code_information":[{"code":"7723106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X70Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Ns","code_information":[{"code":"7723107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Pf                71171228","code_information":[{"code":"7723108","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc Vlp 62Mm 5-Hole 1/3 Tubul Contour Lck Ss Var Ang F/3.5Mm Screw","code_information":[{"code":"7723109","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 5X18Mm Lck Full Thread Std Cortic Ss Hex Recess Head 15Deg Angle Coarse","code_information":[{"code":"7723110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":89.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X14Mm Non-Locking Full Thread Self-Tap Std Cortic Ss Hex Recess Head","code_information":[{"code":"7723111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X16Mm Non-Locking Full Thread Self-Tap Std Cortic Ss Hex Recess Head","code_information":[{"code":"7723112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X18Mm Non-Locking Full Thread Self-Tap Std Cortic Ss Hex Recess Head","code_information":[{"code":"7723113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X26Mm Non-Locking Full Thread Self-Tap Std Cortic Ss Hex Recess Head","code_information":[{"code":"7723114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 32/16Mm P/D 166Mm Bifurc Freeflo Closed Web Iliac Ext E","code_information":[{"code":"7723115","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":30946.0,"discounted_cash":12378.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 16/20Mm P/D 124Mm Bifurc Open-Closed Web Contralateral","code_information":[{"code":"7723116","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27050.0,"discounted_cash":10820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 58Mm 3/7-Hole T-Shaped Compress Lck Lo-Pro Ss Reconstruct Condylar Ankle F/2.4Mm","code_information":[{"code":"7723117","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2589.0,"discounted_cash":1035.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X28Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Dist Radial","code_information":[{"code":"7723118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":77.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.4X16Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Green Dist","code_information":[{"code":"7723119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":164.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 13 155Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723120","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15675.0,"discounted_cash":6270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 10 120Mm Cementls Lo-Pro Collar Coxa Vara Offst Ti Hap 125Deg Angle 12/14","code_information":[{"code":"7723121","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15675.0,"discounted_cash":6270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 32X56Mm Neutral Altrx","code_information":[{"code":"7723122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4250.0,"discounted_cash":1700.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl 12X22X60Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723123","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17107.0,"discounted_cash":6842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 11X380Mm Cannul Rt Lat Entry Femur Ti Light Green Strl","code_information":[{"code":"7723124","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5681.0,"discounted_cash":2272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 11X360Mm Cannul Rt Lat Entry Femur Ti Light Green Strl","code_information":[{"code":"7723125","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5681.0,"discounted_cash":2272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X56Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti T25","code_information":[{"code":"7723126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X70Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Strl","code_information":[{"code":"7723127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.0,"discounted_cash":317.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Cement Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7723128","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13804.0,"discounted_cash":5521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 15 165Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723129","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15675.0,"discounted_cash":6270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Monocryl 5-0 18In 3/8 Circ P-1 Multipass Precision Point Prime Revers Cut Ethalloy Undyed 1","code_information":[{"code":"7723130","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Glenoid Fixat Bigliani/Flatow 52Mm Pegged Uhmwpe Ss Bf","code_information":[{"code":"7723131","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5351.0,"discounted_cash":2140.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral 15X130Mm 48Deg Angle Trabecul Metal","code_information":[{"code":"7723132","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13848.0,"discounted_cash":5539.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Bigliani/Flatow 52Mm Offst 18Mm Modul Zimaloy","code_information":[{"code":"7723133","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6431.0,"discounted_cash":2572.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 15X10.5Cm 6.3Cm 450Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7723134","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":1732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 16X11.3Cm 6.3Cm 550Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7723135","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":1732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 14X9.7Cm 6Cm 375Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7723136","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":1732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Module Emg Mep Conn Meter Nvm5 Mercury-Free Disp","code_information":[{"code":"7723137","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5194.0,"discounted_cash":2077.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Brigade Xl 14X42X30Mm Peek Ant Lumb 8Deg","code_information":[{"code":"7723138","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23074.0,"discounted_cash":9229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Brigade Xl 16X42X30Mm Peek Ant Lumb 8Deg","code_information":[{"code":"7723139","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":23074.0,"discounted_cash":9229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coroent Brigade 4.5X27Mm Ti","code_information":[{"code":"7723140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3168.0,"discounted_cash":1267.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Peri-Loc 2.7Mm Dist Femur Qck-Conn Calib F/Large Frag Targeter","code_information":[{"code":"7723141","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc 98Mm 6-Hole Contour Scallop Lck Ss Lt Lat Prox Tibial F/3.5Mm Screw","code_information":[{"code":"7723142","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5291.0,"discounted_cash":2116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Peri-Loc 2.7X18Mm Provision Targeter Lck Ss Periarticular","code_information":[{"code":"7723143","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Locking 3.5    7382-5060 3.5 X 60 Mm Locking Screw","code_information":[{"code":"7723144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X44Mm Lck Self-Tap Cortic Ss T20 Stardrive Recess Periarticular Cut 3-Flute","code_information":[{"code":"7723145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X40Mm Non-Locking Self-Tap Cortic Ss T20 Stardrive Recess Periarticular Cut","code_information":[{"code":"7723146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":53.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Comprehensive 6Mm Micro 140Mm 45Deg Angle Morse Taper Primary Revers Alignment Hole","code_information":[{"code":"7723147","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10752.0,"discounted_cash":4300.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Humeral Comprehensive 8Mm Position Cntr Pmma","code_information":[{"code":"7723148","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":328.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 32X60Mm Neutral 0Deg Angle Marathon","code_information":[{"code":"7723149","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3651.0,"discounted_cash":1460.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X30X15Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7723150","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13953.0,"discounted_cash":5581.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 13X11Cm 6.7Cm 400Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7723151","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":1732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Natrelle 14X12Cm 7.1Cm 500Ml Saline-Filled Biocell Texture Magna-Site Inject Site","code_information":[{"code":"7723152","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":1732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 380Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Lt","code_information":[{"code":"7723153","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6330.0,"discounted_cash":2532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 11X100Mm Cannul Ti Gold Intertrochan Femur Neck F/Trochanteric Fixat Nail System Strl","code_information":[{"code":"7723154","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.0,"discounted_cash":790.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X30X13Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7723155","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13416.0,"discounted_cash":5366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X75Mm Cannul Helical Solid Ti Femur Gold Strl","code_information":[{"code":"7723156","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":880.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tip Syringe Accell Evo3 6Ga 1.5In Bone Graft","code_information":[{"code":"7723157","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Accell Evo3 Allograft 2.5Ml Dbm 3Rd Gen","code_information":[{"code":"7723158","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2239.0,"discounted_cash":895.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 11.5X400Mm 130Deg Angle Cannul Lck Antegrad Lt Femur Trochan Ti Alloy Lime","code_information":[{"code":"7723159","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6777.0,"discounted_cash":2710.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X60Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723160","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Connector Spinal Spherx Ii 45-50Mm Transverse Variable Ti","code_information":[{"code":"7723161","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4463.0,"discounted_cash":1785.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Manipulator Uterine Rumi Ii 2.5Cm Vag Koh-Eff Hndl Ss Cap Lf Strl Disp F/Harmonic Scalpel/Laser","code_information":[{"code":"7723162","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Manipulator Uterine Rumi Ii 3Cm Vag Koh-Eff Hndl Ss Cap Lf Strl Disp F/Harmonic Scalpel/Laser","code_information":[{"code":"7723163","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Manipulator Uterine Rumi Ii 3.5Cm Vag Koh-Eff Hndl Ss Cap Lf Strl Disp F/Harmonic Scalpel/Laser","code_information":[{"code":"7723164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Manipulator Uterine Rumi Ii 4Cm Vag Koh-Eff Hndl Ss Cap Lf Strl Disp F/Harmonic Scalpel/Laser","code_information":[{"code":"7723165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":108.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone A.L.P.S Sm Lck Timax Rt Calcaneal Foot Ns","code_information":[{"code":"7723166","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2269.0,"discounted_cash":907.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat A.L.P.S 2Mmx6In Kirschner Temp F/Large Frag Plate System","code_information":[{"code":"7723167","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Xia 3 6.5X40Mm Polyaxial Ns","code_information":[{"code":"7723168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6764.0,"discounted_cash":2705.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Xia 3 6X100Mm Non-Hexagonal Non-Threaded Ti Pedicle Thoracolum Ns Laser Etch","code_information":[{"code":"7723169","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":906.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Avs Pl 8X11X25Mm Peek 0Deg","code_information":[{"code":"7723170","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15825.0,"discounted_cash":6330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X36Mm Lck Thread Self-Tap Multi-Direct Cortic Cocr 15Deg Angle Cone Square","code_information":[{"code":"7723171","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X38Mm Lck Thread Self-Tap Multi-Direct Cortic Cocr 15Deg Angle Cone Square","code_information":[{"code":"7723172","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Qck-Conn F/Mini Frag System","code_information":[{"code":"7723173","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 5 105Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723174","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 8 111Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723175","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Putty Bone Graft Equivabone 10Ml Moldable Inject Scaffold Dbm Nanocrystal Cahpo4 10Min Set Time","code_information":[{"code":"7723176","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9416.0,"discounted_cash":3766.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Ba2X Substitute Foam 2Ml Bioactive Resorb Compress Resist B-Tcp","code_information":[{"code":"7723177","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Ba2X Substitute Foam 2.5Ml Bioactive Resorb Compress Resist B-Tcp","code_information":[{"code":"7723178","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1791.0,"discounted_cash":716.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Ba2X Substitute Foam 5Ml Bioactive Resorb Compress Resist B-Tcp Bovine","code_information":[{"code":"7723179","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3324.0,"discounted_cash":1329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pack Filler Bone Graft Vitoss Ba2X Substitute Foam 10Ml Bioactive Resorb Compress Resist B-Tcp","code_information":[{"code":"7723180","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6112.0,"discounted_cash":2444.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo 25X9X15Mm Post Lumb 0Deg F/Interbody Fusion W/Alternate Texturing Ns","code_information":[{"code":"7723181","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10023.0,"discounted_cash":4009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Encompass 19Mm Resurfac Hap","code_information":[{"code":"7723182","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6417.0,"discounted_cash":2566.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 12Mm Long 380Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Lt","code_information":[{"code":"7723183","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6086.0,"discounted_cash":2434.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X105Mm Cannul Helical Solid Ti Femur Gold Strl","code_information":[{"code":"7723184","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2253.0,"discounted_cash":901.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 2 99Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723185","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 5 Cement Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7723186","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 6 Cement Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7723187","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc Vlp 74Mm 6-Hole 1/3 Tubul Contour Lck Ss Var Ang F/3.5Mm Screw","code_information":[{"code":"7723188","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X20Mm Non-Locking Full Thread Self-Tap Std Cortic Ss Hex Recess Head","code_information":[{"code":"7723189","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X10Mm Non-Locking Full Thread Self-Tap Std Cortic Ss Hex Recess Head","code_information":[{"code":"7723190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X16Mm Lck Full Thread Self-Tap Std Cortic Ss Hex Recess Head 15Deg Angle","code_information":[{"code":"7723191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X14Mm Lck Full Thread Self-Tap Std Cortic Ss Hex Recess Head 15Deg Angle","code_information":[{"code":"7723192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4X40Mm Non-Locking Partial Thread Cancell Ss T20 Drive Periarticular F/Small","code_information":[{"code":"7723193","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":68.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 400Mm 125Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7723194","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7532.0,"discounted_cash":3012.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 3Mm 100Cm Smooth Tip","code_information":[{"code":"7723195","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 10.5X120Mm Lag Std Self-Tap Ti Femur F/Cephalomedullary","code_information":[{"code":"7723196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1815.0,"discounted_cash":726.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X60Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7723197","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":258.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X50Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7723198","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.0,"discounted_cash":258.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X28Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7723199","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X12Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7723200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X28Mm Lck Std Ti Magenta Foot F/Small Frag System Ns","code_information":[{"code":"7723201","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X24Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7723202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X32Mm Lck Ti Angle Magenta Foot F/Medium Frag System Ns","code_information":[{"code":"7723203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":191.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.3Mm 5-Hole Qr Cannul F/2/2.4Mm Screw Hps","code_information":[{"code":"7723204","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Fps Sm Medial Column F/3.5/4Mm Screw","code_information":[{"code":"7723205","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2985.0,"discounted_cash":1194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tack Ortho 0.045In Holding","code_information":[{"code":"7723206","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Fps 4X24Mm Lck Std Ti Magenta Foot F/Small Frag System Ns","code_information":[{"code":"7723207","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Filler Bone Graft Osteovation Ex 5Ml Inject Syringe W/Liquid Powder Bowl Spatula Pestle","code_information":[{"code":"7723208","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4463.0,"discounted_cash":1785.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 133Mm 8-Hole Pre-Contoured Compress Lck Ss Fixed Angle Limit-Cont Rt Prox Tibial","code_information":[{"code":"7723209","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5172.0,"discounted_cash":2068.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Lcp 2.8X200Mm Percutan Qck-Conn 100Mm Calibrat Lf Ns F/Plating System","code_information":[{"code":"7723210","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":243.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 3.5X65Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7723211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X70Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7723212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 3.5X80Mm Compress Lck Full Thread Self-Tap Cortic Ss T15 Stardrive Recess Green Prox","code_information":[{"code":"7723213","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coalition 3.6X16Mm Self-Drill Var Ang Ti Ns","code_information":[{"code":"7723214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.0,"discounted_cash":695.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl Std 12X18X55Mm Peek-Optima Extreme Lat","code_information":[{"code":"7723215","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Embolect Tuftex 3Frx6Mmx80Cm 0.2Ml Otw 2Lumen Smooth Bln W/Stopcock Syr Green Polyether","code_information":[{"code":"7723216","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Embolect Tuftex 4Frx10Mmx80Cm 0.75Ml Otw 2Lumen Smooth Bln W/Stopcock Syr Red Polyether","code_information":[{"code":"7723217","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Embolect Tuftex 5Frx80Cm Otw 2Lumen Smooth Bln W/Stopcock Syr White Polyether Block Amide","code_information":[{"code":"7723218","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 6 Cement Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7723219","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Duracon Sm 45Mm 13Mm Lt Rt Artic Surface Constrain","code_information":[{"code":"7723220","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6263.0,"discounted_cash":2505.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 76Mm 4-Hole Contour Low Bend Compress Lck Ss Limit-Cont Rt Prox Tibial F/3.5Mm Screw","code_information":[{"code":"7723221","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5055.0,"discounted_cash":2022.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7723222","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Lead Pacing Quickflex U Bipol 5Frx86Cm 20Mm Space Lt Heart S-Curved Lo-Pro Steer Is-1 Conn Tip Flex","code_information":[{"code":"7723223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":12500.0,"discounted_cash":5000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Putty Bone Graft Equivabone 2.5Ml Moldable Inject Scaffold Dbm Nanocrystal Cahpo4 10Min Set Time","code_information":[{"code":"7723224","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4118.0,"discounted_cash":1647.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Prelude Sheath 5Frx11Cm Femur W/0.035In 50Cm Gw Gray Satin","code_information":[{"code":"7723225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sheath 6F W/Wire Pro-6F-11-038 With Wire","code_information":[{"code":"7723226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Preludepro Sheath 7Frx11Cm W/0.038In 50Cm Gw Orange Satin","code_information":[{"code":"7723227","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Acu-Loc 2 64X11Mm Narrow Lck Ti Std Rt Dist Volar Radial Ns","code_information":[{"code":"7723228","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3567.0,"discounted_cash":1426.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Lg 14X10X35Mm Expand Tooth Peek Post Lumb 5Deg Oblique Ns","code_information":[{"code":"7723229","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13463.0,"discounted_cash":5385.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Ii 6.5X35Mm Polyaxial Ti Post Pedicle Thoracolum","code_information":[{"code":"7723230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2818.0,"discounted_cash":1127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sling Gyn Transobturator Synthetic Perm Macroporous Knit Mid-Urethral","code_information":[{"code":"7723231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1373.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 1.25Mm 150Mm Non-Threaded Cobalt Ss F/3.5/4Mm Cannul Screw Ns","code_information":[{"code":"7723232","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Lcp 99Mm 5-Hole Pre-Contoured Compress Lck Ss Lt Dist Lat Fibula F/2.7/3.5Mm Screw Strl","code_information":[{"code":"7723233","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2326.0,"discounted_cash":930.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X20Mm Compress Lck Full Thread Self-Tap Cortic Ss T8 Stardrive Recess Femur Neck","code_information":[{"code":"7723234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral 13X130Mm 48Deg Angle Trabecul Metal","code_information":[{"code":"7723235","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13315.0,"discounted_cash":5326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Bigliani/Flatow 52Mm Offst 24Mm Modul Zimaloy","code_information":[{"code":"7723236","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6183.0,"discounted_cash":2473.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Glidewire 0.018Inx150Cm 3Cm Tip Angle Flex Std Stiff Shaft Nitinol Hydrphil Tungsten","code_information":[{"code":"7723237","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":72.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Force Fiber #2 38In 1/2 Circ Taper Needle Blue 3910900024 Co-Braid Uhmwpe 39Mm Nonabsorbable","code_information":[{"code":"7723238","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":76.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Force Fiber #2 38In Half Len White Blue 1 Strand/Pk 3910900021 Co-Braid Uhmwpe W/O Needle","code_information":[{"code":"7723239","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Force Fiber #2 38In 1/2 Circ K-Point Blue White 3910900022 Co-Braid Uhmwpe 39Mm Nonabsorbable","code_information":[{"code":"7723240","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Force Fiber #2 38In 1/2 Circ Taper Needle Blue White 1 Strand/Pk 3910900020 Co-Braid Uhmwpe","code_information":[{"code":"7723241","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Force Fiber #5 38In 3/8 Circ Cut Blue 1 Strand/Pk 3910900050 Co-Braid Uhmwpe 49Mm","code_information":[{"code":"7723242","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 3 101Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723243","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pad Therapy Unit Temp-Pad Cold Knee Shoulder Univ 10X11In Random Flow Pliable Insul Slf-Seal Conn","code_information":[{"code":"7723244","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 49X24Mm Narrow Lck Ti Std Rt Dist Volar Radial Ns","code_information":[{"code":"7723245","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3567.0,"discounted_cash":1426.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint X-Fuse Lg 0Deg Superelastic","code_information":[{"code":"7723246","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4253.0,"discounted_cash":1701.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Finger Joint X-Fuse Xl 0Deg Superelastic","code_information":[{"code":"7723247","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4253.0,"discounted_cash":1701.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo 25X9X11Mm Post Lumb 0Deg F/Interbody Fusion W/Alternate Texturing Ns","code_information":[{"code":"7723248","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10023.0,"discounted_cash":4009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 7.3X80Mm Cannul Lag 20Mm Thread Self-Drilling/Tapping Ti Ns","code_information":[{"code":"7723249","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":492.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 6.5Mm 40Mm Thread Qr Cannul F/7.3Mm Screw Hps","code_information":[{"code":"7723250","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1463.0,"discounted_cash":585.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Pps 6.5X40Mm Non-Cannulated Shank Post Thoracolum","code_information":[{"code":"7723251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.0,"discounted_cash":886.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Pps 6.5X35Mm Non-Cannulated Shank Post Thoracolum","code_information":[{"code":"7723252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2216.0,"discounted_cash":886.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Pps Tulip Head Lumb F/5.5Mm Rod Ns","code_information":[{"code":"7723253","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2829.0,"discounted_cash":1131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Pps Lck F/5.5Mm Rod Ns","code_information":[{"code":"7723254","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":332.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X30Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723255","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Independence Lg 39X15X29Mm 15Deg Lordot","code_information":[{"code":"7723258","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":34165.0,"discounted_cash":13666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 9 113Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723259","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 6 107Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723260","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur P.F.C Sigma Size 4 16Mm Wedge/Block Combo Lt Dist Knee Strl Disp","code_information":[{"code":"7723261","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2826.0,"discounted_cash":1130.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 5 83Mm/55Mm 8Mm Curve Post Stabil Fixed Gvf Pe","code_information":[{"code":"7723262","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4018.0,"discounted_cash":1607.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur P.F.C Sigma Cement Bolt Neutral 7Deg Angle Revis Ti Knee","code_information":[{"code":"7723263","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":332.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext S-Rom Noiles 20Mm Univ 75Mm Cement Modul Flute Rotat Hinge Cocr Knee Strl","code_information":[{"code":"7723264","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4163.0,"discounted_cash":1665.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Lcs Complete Univ 46Mm Cntr Ti Full Porous Knee","code_information":[{"code":"7723265","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8346.0,"discounted_cash":3338.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo Tl 30X11X13Mm Transforaminal Lumb 6Deg Lordot F/Interbody Fusion Strl","code_information":[{"code":"7723266","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12530.0,"discounted_cash":5012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Tube Suction/Irrigat Inflow 2-Piercing Spike W/Y-Piece F/Fluid Control Pvc Strl Disp","code_information":[{"code":"7723267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Set Tubing Hysteroscope F/Outflow Fluid Control","code_information":[{"code":"7723268","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Canister Suction Bemis 3000Ml Cap Fluid Disp","code_information":[{"code":"7723269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Tri-Lock Size 3 101Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723270","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 6 107Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723271","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Std 14X18X60Mm Peek-Optima Extreme Lat","code_information":[{"code":"7723272","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Std 10X18X55Mm Expand Tooth Peek-Optima Extreme Lat Thoracolum Rect","code_information":[{"code":"7723273","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Trilogy 20X54Mm Multi-Hole Revis Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7723274","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11715.0,"discounted_cash":4686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Acetabular 10X50Mm Partial Hemis Revis Trabecul Metal Strl","code_information":[{"code":"7723275","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8650.0,"discounted_cash":3460.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Hgp Ii 6.5X30Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cancell Strl","code_information":[{"code":"7723276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 32Mm Shell 0Deg Revis Trabecul Metal","code_information":[{"code":"7723277","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5681.0,"discounted_cash":2272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys 13.5X200Mm 12/14 Taper","code_information":[{"code":"7723278","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":20685.0,"discounted_cash":8274.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 1 97Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723279","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Secur-Fit Size 11 170Mm Cementls Collar Ti Arc Hap Plasma Spray 132Deg Angle Hip","code_information":[{"code":"7723280","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13971.0,"discounted_cash":5588.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe Surg Oscar Scrapper 8Mm Axisymmetric Revers Strl Disp","code_information":[{"code":"7723281","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2970.0,"discounted_cash":1188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe Surg Piercer 8Mm","code_information":[{"code":"7723282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2970.0,"discounted_cash":1188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 3 Cement Stemmed Taper Revis Ti Porous Rt Knee Strl","code_information":[{"code":"7723283","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":3094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 0 95Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723284","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 25/13Mm P/D 166Mm Bifurc Freeflo Closed Web Iliac","code_information":[{"code":"7723285","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29755.0,"discounted_cash":11902.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 16/13Mm P/D 93Mm Bifurc Preload Slf-Expand","code_information":[{"code":"7723286","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14692.0,"discounted_cash":5876.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 32X58Mm Neutral Altrx","code_information":[{"code":"7723287","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4087.0,"discounted_cash":1634.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Fastak 2.4X7.5Mm 17.9Mm Full Thread Preload Nonabsorbable W/2-0 Braid Polyblend - D","code_information":[{"code":"7723288","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl Std 12X18X50Mm Peek-Optima Extreme Lat","code_information":[{"code":"7723289","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 13.1Cm 4Cm Mod Plus-Profile 400Ml Silicone Gel Smooth Ant","code_information":[{"code":"7723290","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2762.0,"discounted_cash":1104.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 14.1Cm 4.3Cm Mod Plus-Profile 500Ml Silicone Gel Smooth Ant","code_information":[{"code":"7723291","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2762.0,"discounted_cash":1104.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 7 109Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723294","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo Tl 30X11X10Mm Transforaminal Lumb 6Deg Lordot F/Interbody Fusion Strl","code_information":[{"code":"7723295","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12530.0,"discounted_cash":5012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Std 8X18X60Mm Expand Tooth Peek-Optima Extreme Lat Thoracolum Rect","code_information":[{"code":"7723296","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 360Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7723297","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":3094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mollring Cutter 5Mm    4200-40","code_information":[{"code":"7723299","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":1820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mollring Cutter 6Mm    4200-41","code_information":[{"code":"7723300","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":1820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mollring Cutter 7Mm    4200-42","code_information":[{"code":"7723301","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":1820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mollring Cutter 8Mm    4200-43","code_information":[{"code":"7723302","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":1820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mollring Cutter 9Mm    4200-44","code_information":[{"code":"7723303","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":1820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Mollring Cutter 10Mm   4200-45","code_information":[{"code":"7723304","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4552.0,"discounted_cash":1820.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Martin Dissector       4200-10","code_information":[{"code":"7723305","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3477.0,"discounted_cash":1390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Periscope Dissector    4200-00","code_information":[{"code":"7723306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3477.0,"discounted_cash":1390.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endohelix Ret Device   4200-20","code_information":[{"code":"7723307","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4817.0,"discounted_cash":1926.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 8 Cement Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7723308","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 99Mm 5-Hole Pre-Contoured Compress Lck Ss Rt Lat Dist Fibula F/2.7/3.5Mm Screw Ns","code_information":[{"code":"7723309","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2269.0,"discounted_cash":907.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X9Mm Compress Lck Thread Self-Drilling/Tapping Cortic Ss T4 Stardrive Recess Hex","code_information":[{"code":"7723310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 1.5X11Mm Compress Lck Thread Self-Drilling/Tapping Ss T4 Stardrive Recess Hex Socket","code_information":[{"code":"7723311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":154.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Ambi Classic Imhs Chs 80Mm 3-Hole 130Deg Angle Compress Std Barrel Hip Keyless","code_information":[{"code":"7723312","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1682.0,"discounted_cash":672.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Versanail 8Mm Univ 280Mm Cannul Lck Humeral Ti Alloy Strl","code_information":[{"code":"7723313","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4454.0,"discounted_cash":1781.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Va-Lcp Sm Compress Lck Ss Var Ang Navicular F/2.4/2.7Mm Screw Strl","code_information":[{"code":"7723314","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4083.0,"discounted_cash":1633.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 40Mm +8.5Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7723315","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6873.0,"discounted_cash":2749.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Trigen 4.3/5X105Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im","code_information":[{"code":"7723316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X30Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7723317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X34Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7723318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X32Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7723319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X24Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7723320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Baseplate Tibial Triathlon Size 2 Univ Cement Stabil Revis Cocr Lt Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7723321","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7264.0,"discounted_cash":2905.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 2 10Mm Half Block Revis Total Stabil Ti Lt Medial Rt Lat Strl","code_information":[{"code":"7723322","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 2 5Mm Half Block Revis Total Stabil Ti Rt Medial Lt Lat Strl","code_information":[{"code":"7723323","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2938.0,"discounted_cash":1175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 2 10Mm Half Block Revis Total Stabil Ti Rt Medial Lt Lat Strl","code_information":[{"code":"7723324","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3007.0,"discounted_cash":1202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 2 16Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7723325","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6038.0,"discounted_cash":2415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 2 19Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7723326","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6038.0,"discounted_cash":2415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 28Mm +8.5Mm Neck 12/14 Taper Modul Biolox Delta Hip","code_information":[{"code":"7723327","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5324.0,"discounted_cash":2129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 7 109Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723328","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 40X60Mm +4 Neutral 10Deg Angle Altrx","code_information":[{"code":"7723329","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6729.0,"discounted_cash":2691.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo Tl 30X11X15Mm Transforaminal Lumb 6Deg Lordot F/Interbody Fusion Strl","code_information":[{"code":"7723330","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12530.0,"discounted_cash":5012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 2 99Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723331","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 4 Cement Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7723332","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl 12X22X50Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723333","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 32/16Mm P/D 145Mm Bifurc Freeflo Closed Web Iliac Ext E","code_information":[{"code":"7723334","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27050.0,"discounted_cash":10820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 16/20Mm P/D 93Mm Bifurc Open-Closed Web Contralateral","code_information":[{"code":"7723335","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8205.0,"discounted_cash":3282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Stent 1Exch202055","code_information":[{"code":"7723336","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14692.0,"discounted_cash":5876.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coalition 18X6X15Mm 7Deg Lordot","code_information":[{"code":"7723337","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12940.0,"discounted_cash":5176.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 6-Hole Lg Purple","code_information":[{"code":"7723338","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2269.0,"discounted_cash":907.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X34Mm Lck Thread Self-Tap Multi-Direct Cortic Cocr 15Deg Angle Cone Square","code_information":[{"code":"7723339","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 3.5X34Mm Non-Locking Lo-Pro Cortic Timax Square Drive Prox Tibial Elbow","code_information":[{"code":"7723340","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 4 103Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723341","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo Tl 30X11X8Mm Transforaminal Lumb 6Deg Lordot F/Interbody Fusion Strl","code_information":[{"code":"7723342","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12530.0,"discounted_cash":5012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Reamer 2.5X650Mm Femur Medullary Canal Ball Tip Deep Flute W/Extension 351.709S Ss Strl","code_information":[{"code":"7723343","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":148.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 400Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Lt","code_information":[{"code":"7723344","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X95Mm Cannul Helical Solid Ti Femur Gold Ns","code_information":[{"code":"7723345","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2155.0,"discounted_cash":862.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 440Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Lt","code_information":[{"code":"7723346","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4X195Mm 3-Flute Quick-Coupling Calib Ss Ns F/Lcp Modul Hand System","code_information":[{"code":"7723347","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X100Mm Cannul Helical Solid Ti Femur Gold Strl","code_information":[{"code":"7723348","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2155.0,"discounted_cash":862.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X60Mm Lck Fully/Double Lead Thread Self-Tapping/Cutting Cortic Ti Hex Recess","code_information":[{"code":"7723349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":258.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X85Mm Lck Fully/Double Lead Thread Self-Tapping/Cutting Cortic Ti Hex Recess","code_information":[{"code":"7723350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":258.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Triathlon Size 6 5Mm Half Block Revis Total Stabil Ti Rt Medial Lt Lat Strl","code_information":[{"code":"7723351","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2938.0,"discounted_cash":1175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 6 Univ Cement Stabil Revis Cocr Lt Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7723352","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7264.0,"discounted_cash":2905.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 7 Cement Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7723353","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13804.0,"discounted_cash":5521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo Tl 30X11X11Mm Transforaminal Lumb 6Deg Lordot F/Interbody Fusion Strl","code_information":[{"code":"7723354","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12530.0,"discounted_cash":5012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Std 4-4.1X16Mm Cannul Compress Headless Full Wide Thread Self-Tapping/Cutting","code_information":[{"code":"7723355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1716.0,"discounted_cash":686.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 Std 4-4.1X20Mm Cannul Compress Headless Full Wide Thread Self-Tapping/Cutting","code_information":[{"code":"7723356","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1716.0,"discounted_cash":686.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 340Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Lt","code_information":[{"code":"7723357","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X90Mm Cannul Helical Solid Ti Femur Gold Ns","code_information":[{"code":"7723358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2155.0,"discounted_cash":862.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat 26Mm Perm F/Small Frag Plate System","code_information":[{"code":"7723359","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 7 Cement Post Stabil Cocr Non-Porous Lt","code_information":[{"code":"7723360","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size E Cement Post Stabil Prolng Zimaloy Lt Lat Knee Strl","code_information":[{"code":"7723361","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15616.0,"discounted_cash":6246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Std 14X18X55Mm Peek-Optima Extreme Lat","code_information":[{"code":"7723362","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Darco 45Mm 6-Hole 2-Slot Lg Compress Lck Ti Mtp Light Blue Ns","code_information":[{"code":"7723363","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5170.0,"discounted_cash":2068.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X8Mm Lck Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx Plate Fixat","code_information":[{"code":"7723364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X14Mm Lck Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx Plate Fixat","code_information":[{"code":"7723365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 10Mm Long 340Mm 125Deg Angle Rt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7723366","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":3094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X35Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7723367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":265.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 3X34Mm Cannul Compress Headless Self-Tapping/Drilling Short Dual Lead Thread Ss","code_information":[{"code":"7723368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":396.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 5 105Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723369","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Quartet Implant Unipol 7Frx86Cm 47Mm Space Lt Ventric S-Type Curve Lo-Pro Multisite","code_information":[{"code":"7723370","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":17868.0,"discounted_cash":7147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Anchor Suture Speedbridge 19.1Mm W/4.75Mm X 15Mm Biocomposite Swivelock 2 Fiber Tape Needle","code_information":[{"code":"7723371","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7078.0,"discounted_cash":2831.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Stent Ureteral Resonance 6Frx24Cm 71.5Cm Cath Metal W/Positioner Sheath Intro Mri-Cond","code_information":[{"code":"7723372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":3070.0,"discounted_cash":1228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Charlotte 2.5X230Mm Kirschner Temp Thread Dbl-End Trocar Point Ss","code_information":[{"code":"7723373","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral 6X130Mm 48Deg Angle Trabecul Metal","code_information":[{"code":"7723374","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13313.0,"discounted_cash":5325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Bigliani/Flatow 40Mm Offst 15Mm Modul Zimaloy","code_information":[{"code":"7723375","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6183.0,"discounted_cash":2473.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 25/16Mm P/D 166Mm Bifurc Freeflo Closed Web Iliac","code_information":[{"code":"7723376","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29755.0,"discounted_cash":11902.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Stent Covered 16/24Mm P/D 124Mm Bifurc Open-Closed Web","code_information":[{"code":"7723377","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14842.0,"discounted_cash":5936.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X120Mm Cannul Helical Solid Ti Femur Gold Ns","code_information":[{"code":"7723378","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":927.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 380Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Rt","code_information":[{"code":"7723379","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Tendon Hunter 4X250Mm Strt Passive Knob End Pes Core Barium Silicone Elastomer Strl Implant","code_information":[{"code":"7723380","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4442.0,"discounted_cash":1776.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Penile Titan Otr Assembly Pump Scrotal","code_information":[{"code":"7723381","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":10130.0,"discounted_cash":4052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Smart Toe Ii 15Mm Neutral 0Deg Flat Nitinol Im F/Claw","code_information":[{"code":"7723382","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lcs Complete Std 17.5Mm Tricompart Fixed Rotat Platform Aox","code_information":[{"code":"7723383","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4171.0,"discounted_cash":1668.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bio Stop Sz 16     5463-16-000","code_information":[{"code":"7723384","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 1 97Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723386","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 3 Cement Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7723387","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Aml 13.5X45X160Mm Cementls Std Offst Collar Lg Stature Ti Full Porocoat 135Deg Angle","code_information":[{"code":"7723388","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14357.0,"discounted_cash":5742.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 8 111Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723389","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Line Etco2 Sampling Male Luer Conn Nafion Disp F/91517 Dual Capnography Module","code_information":[{"code":"7723390","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Applier Clip Epix Universal Lap Inter 5X34Mm 34Cm Shaft Lo-Pro Jaw Ergo Hndl Lf Disp F/10Mm Med Lg","code_information":[{"code":"7723391","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Lap Kii Cann 5X100Mm Adv Fixat W/Seal Abdomin Access","code_information":[{"code":"7723392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Pinnacle 28X52Mm Neutral Altrx","code_information":[{"code":"7723393","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4040.0,"discounted_cash":1616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Interbody Fusion Coroent Xl 12X18X55Mm Expand Tooth Peek Extreme Lat Ns","code_information":[{"code":"7723394","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17451.0,"discounted_cash":6980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 2.8Mm 350Mm Thread Trocar Tip Ti F/Cannulated Screw Ns","code_information":[{"code":"7723395","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent 10X18X55Mm Peek","code_information":[{"code":"7723396","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Journey Size 3-4 11Mm Rt Medial Lt Lat Artic Surface Unicompart Pe","code_information":[{"code":"7723397","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Journey Size 3-4 10Mm Rt Medial Lt Lat Artic Surface Unicompart Pe","code_information":[{"code":"7723398","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3106.0,"discounted_cash":1242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 36/16Mm P/D 166Mm Bifurc Freeflo Closed Web Iliac Ext E","code_information":[{"code":"7723399","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29755.0,"discounted_cash":11902.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Std 10X18X60Mm Expand Tooth Peek-Optima Extreme Lat Thoracolum Rect","code_information":[{"code":"7723400","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Glenoid Fixat Bigliani/Flatow 46Mm Pegged Uhmwpe Ss Bf","code_information":[{"code":"7723401","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5146.0,"discounted_cash":2058.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Hemodialysis Power-Trialysis Acute 13Fr 20Cm 3Lumen Strt Tip Power Inject W/0.035In Gw","code_information":[{"code":"7723402","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Acu-Loc 2 110Mm 7-Hole Contour Lck Lo-Pro Ti Std Lt Olecranon Ns","code_information":[{"code":"7723403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4103.0,"discounted_cash":1641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X14Mm Lck Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate System Ns","code_information":[{"code":"7723404","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.29,"discounted_cash":189.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 3.5X26Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X28Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.7X14Mm Lck Cortic Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.7X20Mm Non-Locking Cortic Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total","code_information":[{"code":"7723408","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"K Wire Laser Marked Ws-1607-St .062 Laser Marked K Wire","code_information":[{"code":"7723409","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 4 103Mm Bps Cementls High Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723412","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cable Ortho Cable-Ready 1.3X889Mm Ss W/Cerclage","code_information":[{"code":"7723413","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Versa-Fx 70Mm 3-Hole 8.7Mm/12.19Mm 130Deg Angle Compress Ss Std Barrel Femur Hip Keyed","code_information":[{"code":"7723414","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx Ii 12.7X115Mm Compress Lag 25Mm Std Thread Ss Hex Head Hip","code_information":[{"code":"7723415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":375.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Xia 3 Radius 6X60Mm Non-Hexagonal Non-Threaded Ti Pedicle Thoracolum Ns Laser Etch","code_information":[{"code":"7723416","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":906.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5X45Mm","code_information":[{"code":"7723417","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6764.0,"discounted_cash":2705.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Xia 3 Radius 6X70Mm Non-Hexagonal Non-Threaded Ti Pedicle Thoracolum Ns Laser Etch","code_information":[{"code":"7723418","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":906.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Connector Spinal Xia 3 43-54Mm Multiaxial Adjust Ti Thoracolum W/Center Nut Ns","code_information":[{"code":"7723419","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6535.0,"discounted_cash":2614.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Suture Surg Tape Achilles F/Pars Jig W/8-#2 Fiberwire Black/White-Green 1.6Mm 2-Needle Nitinol","code_information":[{"code":"7723420","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1567.0,"discounted_cash":626.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Syringe Inject Spectris Solaris Sgl 96In 65Ml 115Ml Cap Low-Pressure Lg Saline/Small Spike","code_information":[{"code":"7723421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Implant Toe Joint Smart Toe Ii 19Mm 1.2Mm Neutral Flat Nitinol","code_information":[{"code":"7723422","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Ceramax 28X52Mm Neutral Ceramic","code_information":[{"code":"7723423","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11124.0,"discounted_cash":4449.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Staple Reload Black     Gst60T Echelon","code_information":[{"code":"7723424","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":158.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys Size 16 145Mm Cement Low Demand/Fracture Zimaloy 12/14 Taper Hip Strl","code_information":[{"code":"7723425","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6385.0,"discounted_cash":2554.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Centralizer Stem Versys 17Mm Cement Press-Fit Pmma Dist Femur Hip Strl","code_information":[{"code":"7723426","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 55Mm Unipol 12/14 Taper Primary Endoprosthesis Zimaloy Hip Strl","code_information":[{"code":"7723427","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1877.0,"discounted_cash":750.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X30X10Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7723429","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13416.0,"discounted_cash":5366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 12X30X10Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7723430","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13416.0,"discounted_cash":5366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen 10X200Mm Cannul Lck Antegrade/Retrograde Lt Hindfoot Humeral Ti Alloy Fusion Lime","code_information":[{"code":"7723431","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9488.0,"discounted_cash":3795.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X95Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im Trochan","code_information":[{"code":"7723432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Legion Size 4 Cement Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7723433","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X30X17Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7723434","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13416.0,"discounted_cash":5366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire 4-0 18In 1/2 Circ Dbl-End Taper Needle Contin Loop Blue Ar-7248 Arthro Braid","code_information":[{"code":"7723435","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire 4-0 18In 3/8 Circ Blue Ar-7230-01 Arthro Braid Uhmwpe 12.3Mm W/Tapered Needle","code_information":[{"code":"7723436","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless 5X100Mm Adv Fixat Sleeve Bln W/Obturator Abdomin","code_information":[{"code":"7723437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":48.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wedge Bone Graft Allopure 22X20Mm 6Mm Evans Cancell F/Cotton Osteotomy","code_information":[{"code":"7723438","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6118.0,"discounted_cash":2447.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wedge Bone Graft Allopure 12X38Mm Evans Cancell","code_information":[{"code":"7723439","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6832.0,"discounted_cash":2732.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl 10X22X60Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723440","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 10 115Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723441","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Electrosurgical Utahloop Cartier 10X10Mm 11Cm Square Loop Y-Shaped Shaft W/Safe-T-Gauge","code_information":[{"code":"7723442","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bone Fixat Dart-Fire Ortholoc 1.4X150Mm Kirschner Temp Blunt Trocar Tip Ns","code_information":[{"code":"7723443","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Dart-Fire Sm 4X42Mm Cannul Compress Headed Partial Thread Self-Drilling/Tapping Ti T15","code_information":[{"code":"7723444","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 4X44Mm Cannul Compress Headed Partial Thread Self-Drilling/Tapping Ti T15","code_information":[{"code":"7723445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.0,"discounted_cash":361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Dart-Fire 3Mm Cannul","code_information":[{"code":"7723446","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Claw Charlotte 20Mm 4-Hole Sm Compress Ss Foot F/3.5Mm Screw","code_information":[{"code":"7723447","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6746.0,"discounted_cash":2698.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte Claw 3.5X26Mm Cannul Compress Lck Thread Ss Hex Head Ankle Foot F/Lisfranc Frx","code_information":[{"code":"7723448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":328.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte Claw 3.5X28Mm Cannul Compress Lck Thread Ss Hex Head Ankle Foot F/Lisfranc Frx","code_information":[{"code":"7723449","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1639.0,"discounted_cash":655.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte Claw 3.5X24Mm Cannul Compress Lck Thread Ss Hex Head Ankle Foot F/Lisfranc Frx","code_information":[{"code":"7723450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":328.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Wide 12X22X60Mm Expand Tooth Peek Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7723451","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Scorpio Nrg Size 7 15Mm Post Stabil X3","code_information":[{"code":"7723452","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5825.0,"discounted_cash":2330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Tube Transgastric-Jejunal Mic-Key Feeding 18Frx45Cm 7-10Ml Bln Taper Tip Tungsten Weighted","code_information":[{"code":"7723453","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Affix Ii 35Mm Bladed Ti S-Shaped Spinous Process Ns","code_information":[{"code":"7723454","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Affix Ii Mini 25Mm Ti Lumb Interspinous Ns","code_information":[{"code":"7723455","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13275.0,"discounted_cash":5310.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Trigen 4.3/5X100Mm Lck Full Thread Inter Captured Cortic Ti 4.7Mm Hex Head Gold Im","code_information":[{"code":"7723456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Lap Kii Cann 12X100Mm Adv Fixat Abdomin Access","code_information":[{"code":"7723457","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless 12X100Mm Adv Fixat Sleeve W/Obturator Abdomin Access","code_information":[{"code":"7723458","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Peek Coroent 12X22X55  6921255 Wide Iordotic Coroent Peek","code_information":[{"code":"7723459","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Device Interbody Fusion Coroent Xl 14X18X60Mm Expand Tooth Peek Extreme Lat 10Deg","code_information":[{"code":"7723460","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17451.0,"discounted_cash":6980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coroent Xl-F 6.5X55Mm Var Ang Ti","code_information":[{"code":"7723461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2985.0,"discounted_cash":1194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Dart-Fire Ortholoc 0.9X150Mm Kirschner Temp Blunt Trocar Tip Ns","code_information":[{"code":"7723462","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 3X40Mm Cannul Compress Headless Partial Thread Self-Drilling/Tapping Ti","code_information":[{"code":"7723463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.2Mm Cannul Compress Strl F/Dart-Fire Screw Sm System","code_information":[{"code":"7723464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Darco Rps 50Mm 8-Hole Lck Ti Reconstruct Medial Column Lat Rearfoot F/3.5Mm Screw","code_information":[{"code":"7723465","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4268.0,"discounted_cash":1707.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X30Mm Non-Locking Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal","code_information":[{"code":"7723466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X20Mm Lck Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal Joint","code_information":[{"code":"7723467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X20Mm Non-Locking Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal","code_information":[{"code":"7723468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X16Mm Non-Locking Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal","code_information":[{"code":"7723469","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X14Mm Non-Locking Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal","code_information":[{"code":"7723470","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X18Mm Non-Locking Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal","code_information":[{"code":"7723471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.5X26Mm Non-Locking Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal","code_information":[{"code":"7723472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5Mm F/Darco Mrs Plate System","code_information":[{"code":"7723473","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular 66Mm Multi-Hole Hemis Primary Revis Modul Solid Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7723474","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10350.0,"discounted_cash":4140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 40X66Mm Std 10.9Mm Neutral 0Deg Angle Full Hemis Primary Modul Longevity Xl","code_information":[{"code":"7723475","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5231.0,"discounted_cash":2092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X50Mm Reduce Head","code_information":[{"code":"7723476","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X65Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7723477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X85Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7723478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X90Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7723479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 5X100Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7723480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Line Gas Sampling Etco2 0.06Inx10Ft Tubing Ext M/M Luer Iso Std Conn Lf","code_information":[{"code":"7723481","type":"CDM"},{"code":"270","type":"RC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Catheter Bln Angioplasty Vascutrak Dilatat Specialty Scoring 2.5X300Mm 140Cm Rx Semi-Compli F/Pta","code_information":[{"code":"7723482","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2239.0,"discounted_cash":895.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Bone Extensure H2 18X30Mm Fresh In Saline Cervical","code_information":[{"code":"7723483","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7049.0,"discounted_cash":2819.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Implant Penile Titan Otr 20Cm Bioflex Silicone Inflate Onetouch Release Scrotal W/Cylinder","code_information":[{"code":"7723485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":21491.0,"discounted_cash":8596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Sustain 10X30X11Mm Tooth Peek Ti Thoracolum Vertebral Oblique","code_information":[{"code":"7723486","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13416.0,"discounted_cash":5366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Tilda R45 Bipol Atrial Is-1 Conn W/Active Screw Fixat","code_information":[{"code":"7723487","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.0,"discounted_cash":866.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Tilda T53 Bipol Rt Atrium/Ventricle Steroid Elut W/Passive Fixat","code_information":[{"code":"7723488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.0,"discounted_cash":866.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Pacing Tilda R53 Bipol Ventricle Is-1 Conn W/Active Screw Fixat","code_information":[{"code":"7723489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.0,"discounted_cash":866.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sealer Lap Ligasure Divider 5Mmx44Cm Texture Jaw Blunt Tip 159Deg Rotat Hand/Foot Switch Ceramic Lf","code_information":[{"code":"7723490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1510.0,"discounted_cash":604.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Cable Ortho 1.6Mm Ss W/Beaded Sleeve","code_information":[{"code":"7723491","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":993.0,"discounted_cash":397.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Vacuum Kiwi Omni-C Sm Lo-Pro Flex Stem Palmpump Traction Force Dehp-Free Strl Disp F/Oa Op Ot","code_information":[{"code":"7723492","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Vicryl #0 27In 1/2 Circ Ct-1 Control Release Taper Point Undyed 8 Strands/Pk Jj41G Uni-Direct","code_information":[{"code":"7723493","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":18.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Fiber Endo Laser Flexiva Pulse Beam 242Um 3M High Power 80Hz Lf Strl Disp","code_information":[{"code":"7723494","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fiber Endo Laser Flexiva Pulse Beam 242Um 3M High Power Lf Strl Disp","code_information":[{"code":"7723495","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 5 Cement Post Stabil Tritanium Cocr Rt F/Total Knee Arthropl Strl","code_information":[{"code":"7723496","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8761.0,"discounted_cash":3504.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 4 13Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7723497","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6038.0,"discounted_cash":2415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"7723498","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 5 Cementls Post Stabil Bead Tritanium Cocr Peri-Apatite Lt F/Total","code_information":[{"code":"7723499","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13720.0,"discounted_cash":5488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 6 9Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7723500","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6038.0,"discounted_cash":2415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Hemostat Pad E-Neptune 2X2In Calcium Alginate Silver Nitrite Lf Strl","code_information":[{"code":"7723501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Allograft Bone Frozen Aseptic Rt Talus Osteochond Foot Ankle","code_information":[{"code":"7723502","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19092.0,"discounted_cash":7636.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Putty Bone Graft Formagraft Sm Cahpo4 Hap","code_information":[{"code":"7723503","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4481.0,"discounted_cash":1792.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Granules Bone Graft Formagraft 20Ml Cahpo4 Hap","code_information":[{"code":"7723504","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5165.0,"discounted_cash":2066.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 15.1Cm 5.9Cm Hp 750Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7723507","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 86Mm 4-Hole Pre-Contoured Compress Lck Ss Rt Lat Dist Fibula F/2.7/3.5Mm Screw Ns","code_information":[{"code":"7723508","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2239.0,"discounted_cash":895.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filter Vasc Gunther Tulip Cardio 30Mm/7Frx50Mm 65Cm Vena Cava Jugular W/Navalign Delivery Nitinol","code_information":[{"code":"7723509","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2687.0,"discounted_cash":1074.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Y Adapter              Map-300 Barb Gibson Cath Lab","code_information":[{"code":"7723510","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 6-Hole Compress Lck Ss Adaption F/1.5Mm Screw W/Guide Ns","code_information":[{"code":"7723511","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1555.0,"discounted_cash":622.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 1.5X8Mm Compress Lck Thread Self-Drilling/Tapping Cortic Ss T4 Stardrive Recess Hex","code_information":[{"code":"7723512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.3X16Mm Non-Locking Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist","code_information":[{"code":"7723513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Liner Acetabular Ceramax 28X58Mm Neutral Ceramic","code_information":[{"code":"7723514","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11124.0,"discounted_cash":4449.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Cannul Compress Strl F/Dart-Fire Sm Screw System","code_information":[{"code":"7723515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 2.5X20Mm Cannul Compress Headless Partial Thread Self-Drilling/Tapping Ti","code_information":[{"code":"7723516","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":384.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 2.5X30Mm Cannul Compress Headless Partial Thread Self-Drilling/Tapping Ti","code_information":[{"code":"7723517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":384.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Genesis Ii Size 3-4 10Mm Compo Hemi Step Wedge/Block Revis Lt Medial Rt Lat W/Screw","code_information":[{"code":"7723518","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4566.0,"discounted_cash":1826.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Legion Size 3 Cement Stemmed Taper Revis Ti Porous Lt Knee Strl","code_information":[{"code":"7723519","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8930.0,"discounted_cash":3572.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Genesis Ii Size 5-6 10Mm Compo Hemi Step Wedge/Block Revis Rt Medial Lt Lat W/Screw","code_information":[{"code":"7723520","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4566.0,"discounted_cash":1826.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Tibial Genesis Ii Size 3-4 10Mm Compo Hemi Step Wedge/Block Revis Rt Medial Lt Lat W/Screw","code_information":[{"code":"7723521","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4566.0,"discounted_cash":1826.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 400Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7723522","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":3094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Natural Nail 5X52.5Mm Full Thread Self-Tap Fixed Angle Cortic Ti 3.5Mm Hex Head Red Femur","code_information":[{"code":"7723523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":265.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Triathlon Size 8 Cement Post Stabil Tritanium Cocr Lt F/Total Knee Arthropl Strl","code_information":[{"code":"7723524","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8761.0,"discounted_cash":3504.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Triathlon 39Mm 11Mm Primary Symm X3 Periapatite F/Total Knee Arthropl Strl","code_information":[{"code":"7723525","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2994.0,"discounted_cash":1197.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 7 13Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7723526","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6038.0,"discounted_cash":2415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Trigen Tan Fan Hex 5Mm Ext Captured Ti F/Intramedullary Nail","code_information":[{"code":"7723527","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire 2X25Mm Headed Ti","code_information":[{"code":"7723528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1.7Mm Cannul Compress Strl F/Dart-Fire Sm Screw System","code_information":[{"code":"7723529","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 13Mm Long 420Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7723530","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":3094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Pin Bone Fixat Bb-Tak 0.045X2.4Mm Arthro Perm Ss","code_information":[{"code":"7723531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X18Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ti T15 Hexalobe Drive Blue Wrist Hand","code_information":[{"code":"7723532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X20Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ti T15 Hexalobe Drive Blue Wrist Hand","code_information":[{"code":"7723533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":90.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X18Mm Compress Full Thread Self-Drilling/Tapping Lo-Pro Cancell Ti T15 Hexalobe Drive","code_information":[{"code":"7723534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X20Mm Compress Full Thread Self-Drilling/Tapping Lo-Pro Cancell Ti T15 Hexalobe Drive","code_information":[{"code":"7723535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Arthro 0.062In Long 5In Trocar Tip Ss Lf Strl Disp","code_information":[{"code":"7723536","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Triathlon Size 7 Cementls Post Stabil Bead Tritanium Cocr Peri-Apatite Rt F/Total","code_information":[{"code":"7723537","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13720.0,"discounted_cash":5488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Triathlon Size 8 Cement Primary Bead Cocr Peri-Apatite Knee","code_information":[{"code":"7723538","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8348.0,"discounted_cash":3339.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Triathlon Size 8 13Mm Artic Surface Post Stabil Bearing X3 F/Total Knee Arthropl Strl","code_information":[{"code":"7723539","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6038.0,"discounted_cash":2415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Revere 5.5X150Mm Curve Non-Threaded Ti Alloy Thoracolum","code_information":[{"code":"7723540","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":312.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Ceramax 28X54Mm Neutral Ceramic","code_information":[{"code":"7723541","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11124.0,"discounted_cash":4449.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Xwide 14X26X60Mm Peek 10Deg","code_information":[{"code":"7723542","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire 2X24Mm Headed Ti","code_information":[{"code":"7723543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Ceramax 28X50Mm Neutral Ceramic","code_information":[{"code":"7723544","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11124.0,"discounted_cash":4449.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 3 66Mm/42Mm 15Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7723545","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4731.0,"discounted_cash":1892.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Sigma Size 3 Cement Post Stabil Modul Tricompart Cocr Porous Rt Strl","code_information":[{"code":"7723546","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9457.0,"discounted_cash":3782.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Electrode Electrosurgical Plasmablade Handpiece 4Mm Tip Spatula Point Highly Insul Rotat Ergo Disp","code_information":[{"code":"7723547","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1048.0,"discounted_cash":419.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl Wide 14X22X55Mm Expand Tooth Peek Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7723548","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Neurostim Artisan 8Mmx70Cm Silicone Platin Pur 8-Contact 2-Port Spinal Cord Lim","code_information":[{"code":"7723549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":11932.0,"discounted_cash":4772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Lead Neurostim Linear St 70Cm Perm 8-Contact Percutan Spinal Cord Strt W/Preloaded Stylet Ring","code_information":[{"code":"7723550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":4475.0,"discounted_cash":1790.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Neurostimulator Implant Precision Spectra Neuromodulation Lf Strl Spinal Cord Bincs Generator","code_information":[{"code":"7723551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":41017.0,"discounted_cash":16406.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Charger Neurostim Precision Spectra Spinal Cord W/Base Station Ac/Dc Power Supply 2.0","code_information":[{"code":"7723552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6649.0,"discounted_cash":2659.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Programmer Neurostim Pt","code_information":[{"code":"7723553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":2915.0,"discounted_cash":1166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Ii 7.5X35Mm Polyaxial Ti Post Pedicle Thoracolum","code_information":[{"code":"7723554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2818.0,"discounted_cash":1127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Trigen Meta-Nail 11.5Mmx38Cm Cannul Lck Retrograd Multi-Planar Prox Tibial Ti Alloy Gold","code_information":[{"code":"7723555","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6280.0,"discounted_cash":2512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless 5X150Mm Adv Fixat Sleeve W/Obturator Abdomin Access","code_information":[{"code":"7723556","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Lap Kii Cann 5X150Mm Adv Fixat Abdomin Access","code_information":[{"code":"7723557","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Trocar Lap Kii Fios 1St Entry Bladeless 12X150Mm Adv Fixat Sleeve W/Obturator Abdomin Access","code_information":[{"code":"7723558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":53.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sleeve Lap Kii Cann 12X150Mm Adv Fixat Abdomin Access","code_information":[{"code":"7723559","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":74.0,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Elevator Neurostim Precision F/Stimulator Passing Device","code_information":[{"code":"7723560","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":74.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tool Tunneler Precision Plus Straw Long 35Cm W/Delivery Preload Hndl Lf Strl Disp F/Spinal Cord","code_information":[{"code":"7723561","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2.7X14Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7723562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Lcp 2.7X12Mm Lck Thread Self-Tap Var Ang Ss T8 Stardrive Recess Round Head Color-Cd Ankle","code_information":[{"code":"7723563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Wrench Neurostim Clik 7.6Cm Anchor Torq Spinal Cord Hex","code_information":[{"code":"7723564","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Anchor Neurostim Clik 2Cm Quick Secure Next Gen Spinal Cord F/Lead Fixat Strl","code_information":[{"code":"7723565","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Introducer Cath Prelude Sheath 6Fr Short 4Cm Lg Inner Diameter Tubing Rotat Suture Ring Kink","code_information":[{"code":"7723566","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Graft Endovascular Endurant Stent Covered 36Mm P/D 49Mm Bifurc Closed Web Aortic Ext Cuff E Delivery","code_information":[{"code":"7723567","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13946.0,"discounted_cash":5578.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Talent Stent Covered 36/18Mm P/D 155Mm Bifurc Woven Aortic Ext Slf-Expand Closed","code_information":[{"code":"7723568","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27891.0,"discounted_cash":11156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Ringloc 36Mm Med +10.5Mm Neck 6Deg Angle Taper Anatomic Cocr Hip Strl","code_information":[{"code":"7723569","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3205.0,"discounted_cash":1282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Acetabular 10X58Mm Partial Hemis Revis Trabecul Metal Strl","code_information":[{"code":"7723570","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9636.0,"discounted_cash":3854.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular 60Mm Multi-Hole Hemis Primary Revis Modul Solid Trabecul Metal Tantalum Tivanium","code_information":[{"code":"7723571","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10350.0,"discounted_cash":4140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys 13.5X190Mm 12/14 Taper","code_information":[{"code":"7723572","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18946.0,"discounted_cash":7578.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Trilogy 32X60X7Mm Offst 8.4Mm Full Hemis Primary Modul Longevity Xl Uhmwpe Strl","code_information":[{"code":"7723573","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5516.0,"discounted_cash":2206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Versys 32Mm +7Mm Neck 12/14 Taper Primary Endoprosthesis Cocr Hip Strl","code_information":[{"code":"7723574","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2964.0,"discounted_cash":1185.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 48Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7723575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":2530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl Xwide 12X26X60Mm Peek 10Deg","code_information":[{"code":"7723576","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Xl Xwide 10X26X60Mm Peek","code_information":[{"code":"7723577","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Burr Surg 4Mm Round 2-Flute Precision Cut Strl F/Elite Core Tps Saber Shank","code_information":[{"code":"7723578","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1048.0,"discounted_cash":419.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Catheter Hemodialysis Power-Trialysis Acute 13Fr 24Cm 3Lumen Strt Tip Power Inject W/0.035In Gw","code_information":[{"code":"7723579","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Vasc Vascure 1X10Cm 5/Pk","code_information":[{"code":"7723580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":472.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Legion Size 8 Cement Post Stabil Cocr Non-Porous Rt","code_information":[{"code":"7723581","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14319.0,"discounted_cash":5727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 28X48Mm Neutral Altrx","code_information":[{"code":"7723582","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4040.0,"discounted_cash":1616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Bio-Tenodesis 4X10Mm Peek Full Thread Vent F/Drilling Graft Tensioning","code_information":[{"code":"7723583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Arthro Sm W/2.4Mm Guidepin Suture Passing Wire No2 Fiberwire Fiber Loop Ndl Ruler Lf Disp","code_information":[{"code":"7723584","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":299.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Aml 15X45X160Mm Cementls Std Offst Collar Lg Stature Ti Full Porocoat 135Deg Angle 12/14","code_information":[{"code":"7723585","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14357.0,"discounted_cash":5742.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +8.5Mm Neck 12/14 Taper Modul Total Stabil Biolox Delta Ts Hip","code_information":[{"code":"7723586","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9138.0,"discounted_cash":3655.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Xwide 12X26X60Mm Peek","code_information":[{"code":"7723587","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Bag Spec Retriev Inzii Lap 12/15Mm Port 1600Ml Cap Cylindr Guide Bead Extra Wide Open Lf Disp","code_information":[{"code":"7723589","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Versa-Fx Ii 12.7X90Mm Compress Lag 25Mm Std Thread Ss Hex Head Hip","code_information":[{"code":"7723590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":374.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Versa-Fx Ii 3.2Mm 230Mm Calib Femur","code_information":[{"code":"7723591","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx 4.5X36Mm Lck Full Thread Self-Tap Cortic Ss Hex Recess F/Large Frag System Ns","code_information":[{"code":"7723592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx 4.5X38Mm Lck Full Thread Self-Tap Cortic Ss Hex Recess F/Large Frag System Ns","code_information":[{"code":"7723593","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 4.5Mm Cannul Quick-Coupling Reus F/6.5Mm Screw Fixat","code_information":[{"code":"7723594","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":507.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5Mm Std 75Mm Cannul Non-Locking 16Mm Thread Self-Drilling/Tapping Biodur 108 Alloy Hex","code_information":[{"code":"7723595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Reproc 3.2X145Mm Qck-Conn Ss","code_information":[{"code":"7723596","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Ceramax 28X48Mm Neutral Ceramic","code_information":[{"code":"7723597","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11124.0,"discounted_cash":4449.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc 193Mm 8-Hole Contour Scallop Lck Ss Rt Lat Dist Femur F/4.5Mm Screw","code_information":[{"code":"7723598","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5521.0,"discounted_cash":2208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X68Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Sigma Tc3 Size 3 71Mm/47Mm 12.5Mm Post Stabil Rotat Platform Uhmwpe","code_information":[{"code":"7723600","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7105.0,"discounted_cash":2842.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial S-Rom Noiles Size 3 45.8/69.6Mm 4.8Mm Cement Post Stabil Tricompart Revis","code_information":[{"code":"7723601","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13233.0,"discounted_cash":5293.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur P.F.C Sigma Size 3 4Mm Wedge/Block Lt Dist Knee Strl Disp","code_information":[{"code":"7723602","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur P.F.C Sigma Tc3 Size 3 61/66Mm Cement Post Stabil C/S Revis Cocr Non-Porous Lt","code_information":[{"code":"7723603","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16438.0,"discounted_cash":6575.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Tibial Mbt Lcs Complete 53Mm 40Mm Metaphyseal Knee Modul Revis Tray Pe Porous F/Lps","code_information":[{"code":"7723604","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7275.0,"discounted_cash":2910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext S-Rom Noiles 18Mm Univ 75Mm Cement Modul Flute Rotat Hinge Cocr Knee Strl","code_information":[{"code":"7723605","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4163.0,"discounted_cash":1665.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur P.F.C Sigma Size 3 4Mm Wedge/Block Cement Combo Post Knee Strl Disp","code_information":[{"code":"7723606","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X74Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 6.5X65Mm Non-Locking Cannul 24Mm Partial Thread Cancell Ss T25 Drive Ankle","code_information":[{"code":"7723608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":77.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X50Mm Non-Locking Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute","code_information":[{"code":"7723609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X64Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X60Mm Non-Locking Self-Tap Lo-Pro Cortic Ss F/Large Frag System","code_information":[{"code":"7723611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X30Mm Non-Locking Self-Tap Lo-Pro Cortic Ss F/Large Frag System","code_information":[{"code":"7723612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":47.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 187Mm 10-Hole Pre-Contoured Low Bend Compress Lck Ss Rt Dist Medial Tibial F/3.5Mm","code_information":[{"code":"7723613","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5312.0,"discounted_cash":2124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 11.7Cm 4.8Cm Hp 350Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7723614","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 13.2Cm 5.3Cm Hp 500Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7723615","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 10.5Cm 4.3Cm Hp 250Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7723616","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 6X20Mm 80Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723617","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 7X20Mm 80Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723618","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 6X40Mm 80Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723619","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 7X40Mm 80Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723620","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 8X40Mm 80Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723621","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 5X40Mm 80Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723622","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 10X40Mm 80Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723623","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl Wide 10X22X60Mm Expand Tooth Peek Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7723624","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl 8X22X55Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723625","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-C 14X17X8Mm Self-Guided Self-Locking Standalone Peek-Optima Cervical Lordot Color-Cd","code_information":[{"code":"7723626","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Roi-C Long 5-7Mm Lck Ti Cervical F/H8-H10 Cage Anchoring","code_information":[{"code":"7723627","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Profix Size 4 14Mm Rt Artic Surface Conforming Plus","code_information":[{"code":"7723628","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5334.0,"discounted_cash":2133.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dorado Balloon 4X2 40Cm Dr4042","code_information":[{"code":"7723629","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 5X40Mm 40Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723630","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dorado Balloon 6X2 40Cm Dr4062","code_information":[{"code":"7723631","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 8X40Mm 120Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723632","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Bln Angioplasty Dorado Post-Dilatation 10X40Mm 120Cm Otw Non-Compli 3Lumen Coaxial F/Pta","code_information":[{"code":"7723633","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Versa-Fx 86Mm 4-Hole 8.7Mm/12.19Mm 140Deg Angle Compress Ss Femur Hip Keyless Strl","code_information":[{"code":"7723634","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx Ii 12.7X85Mm Compress Lag 25Mm Std Thread Ss Hex Head Hip","code_information":[{"code":"7723635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":375.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx 4.5X44Mm Full Thread Self-Tap Cortic Ss Hex Recess F/Large Frag System Ns","code_information":[{"code":"7723636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx 4.5X40Mm Full Thread Self-Tap Cortic Ss Hex Recess F/Large Frag System Ns","code_information":[{"code":"7723637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho Peri-Loc 3.2Mm 300Mm Thread Ss Strl Disp","code_information":[{"code":"7723638","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Peri-Loc 5.5Mm Qck-Conn Cannul Calib F/8Mm Screw","code_information":[{"code":"7723639","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lg 6.5X85Mm Cannul 22Mm Partial Thread Self-Drilling/Tapping Ti Hex Drive Revers Cut","code_information":[{"code":"7723640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lg 6.5X75Mm Cannul 22Mm Partial Thread Self-Drilling/Tapping Ti Hex Drive Revers Cut","code_information":[{"code":"7723641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.0,"discounted_cash":418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Xwide 12X26X55Mm Peek 10Deg","code_information":[{"code":"7723642","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo 25X9X12Mm Post Lumb 0Deg F/Interbody Fusion W/Alternate Texturing Ns","code_information":[{"code":"7723643","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10023.0,"discounted_cash":4009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Roi-C Short Std 5-7Mm Lck Ti Cervical F/H8-H10 Cage Anchoring","code_information":[{"code":"7723644","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-C 14X17X7Mm Self-Guided Self-Locking Standalone Peek-Optima Cervical Lordot Color-Cd","code_information":[{"code":"7723645","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 65Mm 3-Hole Contour Lck Lo-Pro Ti Std Lt Olecranon Ns","code_information":[{"code":"7723646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4103.0,"discounted_cash":1641.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X40Mm Lck Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate System Ns","code_information":[{"code":"7723647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X12Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723648","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 3.5X14Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Acu-Loc 2 3.5X40Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7723650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Nexgen Legacy Size Ef/3-4 14Mm Artic Surface Post Stabil Fixed Bearing Flexion Prolng","code_information":[{"code":"7723652","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5845.0,"discounted_cash":2338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-C 14X17X6Mm Self-Guided Self-Locking Standalone Peek-Optima Cervical Lordot Color-Cd","code_information":[{"code":"7723653","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Spacer Spinal Valeo 25X9X14Mm Post Lumb 0Deg F/Interbody Fusion W/Alternate Texturing Ns","code_information":[{"code":"7723654","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9131.0,"discounted_cash":3652.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Natural Nail 11.5Mm Long 320Mm 125Deg Angle Lt Cephalomedullary Femur Ti Alloy","code_information":[{"code":"7723655","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":3094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 340Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Rt","code_information":[{"code":"7723656","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X110Mm Cannul Helical Solid Ti Femur Gold Ns","code_information":[{"code":"7723657","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":862.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Defibrillator Cardiac Energen Dr Implant 6.17Cm X 6.90-7.40X0.99Cm 72Gm 2-Chamber Df-4 Conn Lf Strl","code_information":[{"code":"7723658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":65621.0,"discounted_cash":26248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Ringloc+ Size 24 36Mm 10Deg Angle Lck Ring Arcomxl Strl","code_information":[{"code":"7723659","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4654.0,"discounted_cash":1861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur G7 36Mm -6Mm Neck Type 1 Taper Modul Non-Skirted Cocr Hip Strl","code_information":[{"code":"7723660","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2222.0,"discounted_cash":888.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Acetabular Ringloc Size 24 Replace Lck Ti","code_information":[{"code":"7723661","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":134.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Bio-Tenodesis Cannul 7X23Mm Biocomposite Plla Full Thread Vent F/Drilling Graft","code_information":[{"code":"7723662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Interference Bio-Tenodesis Cannul 6.25X15Mm Biocomposite Plla Full Thread Vent F/Drilling","code_information":[{"code":"7723663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Probe Electrosurgical Monopol Stimulating 3Mm 100Mm Electrode Ball Non-Insulated Insul Shaft","code_information":[{"code":"7723664","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent Xl Wide 10X22X55Mm Expand Tooth Peek Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7723665","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Xl Xwide 10X26X55Mm Peek 10Deg","code_information":[{"code":"7723666","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Biopsy Formagraft Device 8In F/Aspiration Bone Marrow","code_information":[{"code":"7723667","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 135Mm 6-Hole Pre-Contoured Low Bend Compress Lck Ss Rt Dist Medial Tibial F/3.5Mm","code_information":[{"code":"7723668","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5207.0,"discounted_cash":2082.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X50Mm Cannul Lag Partial Thread Self-Drilling/Tapping Reduce Head Cancell Timax Ns","code_information":[{"code":"7723669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat Dart-Fire Ortholoc 1.1X150Mm Kirschner Temp Blunt Trocar Tip Ns","code_information":[{"code":"7723670","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 3X20Mm Cannul Compress Headed Partial Thread Self-Drilling/Tapping Ti T10","code_information":[{"code":"7723671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 3X26Mm Cannul Compress Headed Partial Thread Self-Drilling/Tapping Ti Grn","code_information":[{"code":"7723672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 3X25Mm Cannul Compress Headed Partial Thread Self-Drilling/Tapping Ti T10","code_information":[{"code":"7723673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 3X36Mm Cannul Compress Headed Partial Thread Self-Drilling/Tapping Ti Grn","code_information":[{"code":"7723674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Hded 3.0 X 30  Din30030S Dartfire Headed 3.0 X 30 Scre","code_information":[{"code":"7723675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2X120Mm F/Darco Mfs System","code_information":[{"code":"7723676","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X18Mm Lck Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx Plate Fixat","code_information":[{"code":"7723677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Journey Size 3-4 8Mm Lt Medial Rt Lat Artic Surface Unicompart Pe","code_information":[{"code":"7723678","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":1342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Journey Size 4 Unicompart Lt Medial Rt Lat","code_information":[{"code":"7723679","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5936.0,"discounted_cash":2374.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Xl Xwide 10X26X55Mm Peek","code_information":[{"code":"7723680","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X30Mm Pre-Bent 1-Ball Ended Ti Ns","code_information":[{"code":"7723681","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":806.0,"discounted_cash":322.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys 16X160Mm Primary Offst Collar Midcoat Tivanium Porous Fiber Metal Strt Std Body","code_information":[{"code":"7723682","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18568.0,"discounted_cash":7427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 2.7X16Mm Lck Full Thread Self-Tap Cortic Ti Forefoot F/Radial Head Frx Plate Fixat","code_information":[{"code":"7723683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 3X24Mm Cannul Compress Headless Partial Thread Self-Drilling/Tapping Ti","code_information":[{"code":"7723684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":397.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Versa-Fx 86Mm 4-Hole 8.7Mm/12.19Mm 130Deg Angle Compress Ss Femur Hip Keyless Strl","code_information":[{"code":"7723685","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1445.0,"discounted_cash":578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx Ii 12.7X100Mm Compress Lag 25Mm Std Thread Ss Hex Head Hip","code_information":[{"code":"7723686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":375.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Versa-Fx 4.5X42Mm Full Thread Self-Tap Cortic Ss Hex Recess F/Large Frag System Ns","code_information":[{"code":"7723687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X35Mm Pre-Bent 1-Ball Ended Ti Ns","code_information":[{"code":"7723688","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fiber Endo Laser Flexiva Pulse Beam 365Um 2.6M High Power Lf Strl Disp","code_information":[{"code":"7723689","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Fiber Endo Laser Flexiva Pulse Beam 550Um 2.6M High Power Lf Strl Disp","code_information":[{"code":"7723690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Fiber Endo Laser Flexiva Pulse Beam 910Um 2.6M High Power Lf Strl Disp","code_information":[{"code":"7723691","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Augment Acetabular Pinnacle 54/56Mm 15Mm Buttress Revis Gription Ti Foam Strl","code_information":[{"code":"7723692","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":2816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filter Vasc Gunther Tulip Cardio 30Mm/7Frx50Mm 65Cm Vena Cava Femur W/Navalign Delivery Nitinol","code_information":[{"code":"7723693","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2687.0,"discounted_cash":1074.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Xl Xwide 10X26X60Mm Peek 10Deg","code_information":[{"code":"7723694","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 300Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Lt","code_information":[{"code":"7723695","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 400Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Rt","code_information":[{"code":"7723696","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X115Mm Cannul Helical Solid Ti Femur Gold Ns","code_information":[{"code":"7723697","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2155.0,"discounted_cash":862.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone F3 11.7X45.3Mm 2D Contour Compress Lck Timax High Strength Rt Wrist F/Small Frag Frx Ns","code_information":[{"code":"7723698","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1617.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat A.L.P.S 2.5X20Mm Screw Lck Perm Round Full Thread Ti Dist Radial Volar F/Hand Frx","code_information":[{"code":"7723699","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Suturetak 2.4Mm Mini 8.5Mm Preload Push-In Flex Eyelet Absorb W/2-0 Fiberwire","code_information":[{"code":"7723700","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":521.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Anchor Suture Bio-Pushlock Knotless 2.5Mm Mini 8Mm Absorb F/Collateral Ligament Repair Thumb Plla","code_information":[{"code":"7723701","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1454.0,"discounted_cash":581.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Arthro Suturetak Mini Biocompat W/1.8/2.0Mm Bit Punch Drill Guide Suture Instrument Strl Disp","code_information":[{"code":"7723702","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":299.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Roi-C 14X15.5X6Mm Self-Guided Self-Locking Standalone Peek-Optima Cervical Lordot","code_information":[{"code":"7723703","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Device Retriev Gunther Tulip Filter 60Cm Vena Cava W/6.3/11Fr Intro Sheath 80Cm Loop System","code_information":[{"code":"7723704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":674.0,"discounted_cash":269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Maxillary Adult Spin   Rs0616M Spin Kit Balloon","code_information":[{"code":"7723705","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":2159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Mini-Calc 8-Hole Lg Lck Ti Std Rt Lat Wall Calcaneal Combo Ns","code_information":[{"code":"7723706","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3880.0,"discounted_cash":1552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X28Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7723707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lg 6.5X100Mm Cannul 22Mm Partial Thread Self-Drilling/Tapping Ti Hex Drive Revers Cut","code_information":[{"code":"7723708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.0,"discounted_cash":442.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lg 6.5X95Mm Cannul 22Mm Partial Thread Self-Drilling/Tapping Ti Hex Drive Revers Cut","code_information":[{"code":"7723709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.0,"discounted_cash":442.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg Wide 11X26X10Mm Impacted Peek 4Deg","code_information":[{"code":"7723710","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12819.0,"discounted_cash":5127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X75Mm Pre-Bent 1-Ball Ended Ti Ns","code_information":[{"code":"7723711","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4472.0,"discounted_cash":1788.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 31Mm 3-Hole Sm Curve Lck Ti Std Midshaft Volar Radial Head Forearm Ns","code_information":[{"code":"7723712","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3589.0,"discounted_cash":1435.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tap Surg 2.3Mm F/Distal Radius Frag Specific Plate Screw","code_information":[{"code":"7723713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.3X12Mm Non-Locking Full Thread Cortic Ti Dist Volar Radial Clavicle Wrist","code_information":[{"code":"7723714","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Elbow Joint 22Mm 4Deg Angle Anatomic Ti Lt Radial F/Arh Solutions 2 System Strl","code_information":[{"code":"7723715","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8208.0,"discounted_cash":3283.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 135Mm 6-Hole Pre-Contoured Low Bend Compress Lck Ss Lt Dist Medial Tibial Strl","code_information":[{"code":"7723716","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5207.0,"discounted_cash":2082.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg 9X26X12Mm Impacted Peek 4Deg Narrow","code_information":[{"code":"7723717","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12819.0,"discounted_cash":5127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg Wide 11X26X12Mm Impacted Peek 4Deg","code_information":[{"code":"7723718","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12819.0,"discounted_cash":5127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X40Mm Pre-Bent 1-Ball Ended Ti Ns","code_information":[{"code":"7723719","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":801.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone F3 11.7X45.3Mm 2D Contour Compress Lck Timax High Strength Lt Wrist F/Small Frag Frx Ns","code_information":[{"code":"7723720","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1617.0,"discounted_cash":646.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Spherx Ii 6.5X40Mm Cannul Multiaxial Thread Dual Head Pedicle Hap","code_information":[{"code":"7723721","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2818.0,"discounted_cash":1127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg 11X26X11Mm Impacted Peek 4Deg Narrow","code_information":[{"code":"7723722","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12819.0,"discounted_cash":5127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Formagraft Sm 4X15X22.5Mm Void B-Tcp Ha Bovine Tendon Type I Collagen","code_information":[{"code":"7723723","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2378.0,"discounted_cash":951.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X75Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723724","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X56Mm +4 Neutral Marathon","code_information":[{"code":"7723725","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3015.0,"discounted_cash":1206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Journey Ii Med Unicompart Oxinium Lt Patellofemoral","code_information":[{"code":"7723726","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18270.0,"discounted_cash":7308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal 6.5X35Mm Cannul Multiaxial Thread Dual Head Pedicle Hap","code_information":[{"code":"7723727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2818.0,"discounted_cash":1127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X85Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723728","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ortholoc 3Dsi 3.5X32Mm Compress Lck Polyaxial Thread Self-Tap Cortic Ss Purple Ankle Foot","code_information":[{"code":"7723729","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ortholoc 3Dsi 2.7X20Mm Compress Lck Polyaxial Thread Self-Tap Cortic Ss Green Ankle Foot","code_information":[{"code":"7723730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Claw Ii Ortholoc 3Dsi 19X22Mm 4-Hole Med U-Shaped Compress Lck Ss Polyaxial","code_information":[{"code":"7723731","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8197.0,"discounted_cash":3278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Claw Ii Ortholoc 3Dsi 10X30Mm 4-Hole Sm U-Shaped Compress Lck Ss Polyaxial Ns","code_information":[{"code":"7723732","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8197.0,"discounted_cash":3278.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ortholoc 3Dsi 3.5X28Mm Compress Lck Polyaxial Thread Self-Tap Cortic Ss Purple Ankle Foot","code_information":[{"code":"7723733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ortholoc 3Dsi 2.7X16Mm Compress Lck Polyaxial Thread Self-Tap Cortic Ss Green Ankle Foot","code_information":[{"code":"7723734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ortholoc 3Dsi 2.7X22Mm Compress Lck Polyaxial Thread Self-Tap Cortic Ss Green Ankle Foot","code_information":[{"code":"7723735","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ortholoc 3Dsi 3.5X22Mm Compress Lck Polyaxial Thread Self-Tap Cortic Ss Purple Ankle Foot","code_information":[{"code":"7723736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":318.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Green F/Claw Ii 2.7Mm Screw","code_information":[{"code":"7723737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.8Mm Femur Purple F/2.7Mm Screw Claw Ii Plate","code_information":[{"code":"7723738","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Mini-Calc 8-Hole Lg Lck Ti Lt Lat Wall Calcaneal Blue Ns","code_information":[{"code":"7723739","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3880.0,"discounted_cash":1552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X32Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7723740","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X34Mm Non-Locking Cortic Ti Hex Drive Blue Radial Elbow Clavicle Shoulder","code_information":[{"code":"7723741","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X26Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7723742","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X30Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7723743","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":135.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X34Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7723744","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":258.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bolt Im Nail 6.5X85Mm Ss Midfoot Ns","code_information":[{"code":"7723745","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1877.0,"discounted_cash":750.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho 2.8Mm 300Mm Non-Threaded Trocar Point Ss F/4.5/6.5Mm Compress Screw Ns","code_information":[{"code":"7723746","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 5X300Mm Midfoot 3-Flute Quick-Coupling Cannul 200Mm Calib Ss Ns F/6.5Mm Fusion Bolt","code_information":[{"code":"7723747","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1424.0,"discounted_cash":569.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 6.5X330Mm Cannul Quick-Coupling Calib Ss Ns","code_information":[{"code":"7723748","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":918.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 16/24Mm P/D 156Mm Bifurc Preload Slf-Expand","code_information":[{"code":"7723749","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19092.0,"discounted_cash":7636.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 16/28Mm P/D 156Mm Bifurc Preload Slf-Expand","code_information":[{"code":"7723750","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19092.0,"discounted_cash":7636.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 16/24Mm P/D 124Mm Bifurc Preload Slf-Expand","code_information":[{"code":"7723751","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14842.0,"discounted_cash":5936.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Wide 14X22X55Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723752","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Prostalac Size 1 105Mm Cement Revis High Offst Cocr 135Deg Angle Lt Hip","code_information":[{"code":"7723753","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9434.0,"discounted_cash":3773.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rasp Surg Tps 3.2Mm Long 18.3Mm Helicoidal Tc Strl F/Midas Rex Zimmer Ultrapower","code_information":[{"code":"7723754","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Roi-A Median 27X36X14Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 6Deg Lordot Green","code_information":[{"code":"7723755","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16079.0,"discounted_cash":6431.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Roi-A Med +0.5Mm Lck Load Ti Ant Lumb F/Anchoring","code_information":[{"code":"7723756","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9364.0,"discounted_cash":3745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Acetabular Trilogy 6.5X50Mm 0Deg Angle Full Hemis Self-Tap Countersink Head Ss Cancell Strl","code_information":[{"code":"7723757","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Explant 56Mm  7053-56-10","code_information":[{"code":"7723758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3133.0,"discounted_cash":1253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Full Explant  7053-56-20","code_information":[{"code":"7723759","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3133.0,"discounted_cash":1253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Flexhd Structural Thk 6X12Cm 0.8-1.7Mm Hydrat Acell Dermal Matrix","code_information":[{"code":"7723760","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7593.0,"discounted_cash":3037.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-A Median 27X36X12Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 10Deg Lordot Green","code_information":[{"code":"7723761","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16079.0,"discounted_cash":6431.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 2.7X38Mm Non-Cannulated Non-Locking Full Thread Self-Tap Cortic Timax Hex Drive","code_information":[{"code":"7723762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":84.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone A.L.P.S 2.7X50Mm Non-Cannulated Non-Locking Full Thread Self-Tap Cortic Timax Hex Drive","code_information":[{"code":"7723763","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":84.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Expert 3.2Mm 290Mm Thread Trocar Spade Point One End Ss F/Humeral Instrument Ti","code_information":[{"code":"7723764","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":136.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Nail-Ex 10X380Mm Round Cannul Antegrade/Retrograde Femur Ti Alloy Green Strl","code_information":[{"code":"7723765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5981.0,"discounted_cash":2392.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X80Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Ns","code_information":[{"code":"7723766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X60Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Ns","code_information":[{"code":"7723767","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X40Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Ns","code_information":[{"code":"7723768","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X36Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Ns","code_information":[{"code":"7723769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X38Mm Cannul Compress Lck Fully/Double Lead Thread Self-Tap Cortic Ti Ns","code_information":[{"code":"7723770","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Endcap Ortho Expert 9-12Mm Cannul T40 Stardrive Recess 0Mm Ext Lck Protect Ti Femur Gray Strl","code_information":[{"code":"7723771","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guide Drill Lcp 2Mm Thread W/Depth Gauge Ns F/2.7Mm Lck Screw Insert","code_information":[{"code":"7723772","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1978.0,"discounted_cash":791.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 38Mm 5-Hole Strt Compress Lck Lo-Pro Ss Reconstruct Condylar Ankle F/2Mm Screw Mini","code_information":[{"code":"7723773","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":882.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 45Mm 6-Hole Strt Compress Lck Lo-Pro Ss Reconstruct Condylar Ankle F/2Mm Screw Mini","code_information":[{"code":"7723774","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":882.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2X10Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess F/Modular Mini","code_information":[{"code":"7723775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2X8Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess Wrist Hand","code_information":[{"code":"7723776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2X10Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess Wrist Hand","code_information":[{"code":"7723777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2X11Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess Wrist Hand","code_information":[{"code":"7723778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2X12Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess Wrist Hand","code_information":[{"code":"7723779","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dcp 2X14Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess Wrist Hand","code_information":[{"code":"7723780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 1.5X96Mm Maxillofacial Cannul Quick-Coupling Jacobs Chuck End W/Depth Mark Gold Ss Ns","code_information":[{"code":"7723781","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl 10X18X55Mm Expand Tooth Peek-Optima Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7723782","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15174.0,"discounted_cash":6069.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Forceps Spec Retriev Rescue Alligator Grasp 2.4Mmx230Cm 8Mm Jaw Rat Tooth 2.8Mm Channel","code_information":[{"code":"7723783","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":157.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Insufflation Needles     C2202","code_information":[{"code":"7723784","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Charlotte 2X11Mm Self-Drilling/Tapping Snap-Off Smooth Head Ti Tarsometatarsal","code_information":[{"code":"7723785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":375.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Turbohawk              Th-Ls-M","code_information":[{"code":"7723786","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9249.0,"discounted_cash":3699.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 3.2Mm 12In Partial Thread Trocar Tip Smooth Shaft F/Cannulated Screw System","code_information":[{"code":"7723787","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5Mm Std 90Mm Cannul Non-Locking 16Mm Thread Self-Drilling/Tapping Biodur 108 Alloy Hex","code_information":[{"code":"7723788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5Mm Std 95Mm Cannul Non-Locking 16Mm Thread Self-Drilling/Tapping Biodur 108 Alloy Hex","code_information":[{"code":"7723789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 3 66Mm/42Mm 12.5Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7723790","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4731.0,"discounted_cash":1892.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc 230Mm 10-Hole Contour Scallop Lck Ss Rt Lat Dist Femur F/4.5Mm Screw","code_information":[{"code":"7723791","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5967.0,"discounted_cash":2386.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X36Mm Non-Locking Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute","code_information":[{"code":"7723792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X74Mm Non-Locking Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute","code_information":[{"code":"7723793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X80Mm Non-Locking Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute","code_information":[{"code":"7723794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X24Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X48Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723796","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X78Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723797","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Tri-Lock Size 9 113Mm Bps Cementls Std Offst Gription 130Deg Angle 12/14 Taper Bone","code_information":[{"code":"7723798","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15330.0,"discounted_cash":6132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 3.2Mm 9In Partial Thread Trocar Tip F/Cannulated Screw System","code_information":[{"code":"7723799","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.5Mm Std 80Mm Cannul Non-Locking 16Mm Thread Self-Drilling/Tapping Biodur 108 Alloy Hex","code_information":[{"code":"7723800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X70Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723804","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.8X250/95Mm Mandibular Quick-Coupling Calib W/Stop F/Lcp System","code_information":[{"code":"7723805","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5Mm 250X95Mm Mandibular Dist Tibial Quick-Coupling Calib W/Stop F/Lcp System","code_information":[{"code":"7723806","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Wire Bone Fixat Lcp 1.6X200Mm Kirschner Temp Drill Tip Ss W/Guide Ns","code_information":[{"code":"7723807","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":84.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Lead Neurostim Tilda Tined","code_information":[{"code":"7723808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":657.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Xl Xwide 10X26X50Mm Peek","code_information":[{"code":"7723809","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 420Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Rt","code_information":[{"code":"7723810","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6408.0,"discounted_cash":2563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X58Mm +4 Neutral Marathon","code_information":[{"code":"7723811","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4339.0,"discounted_cash":1735.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Journey Ii Sm Unicompart Oxinium Lt Patellofemoral","code_information":[{"code":"7723812","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18270.0,"discounted_cash":7308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Penile Macroplastique Bulking Agent 2.5Ml Polydimethylsiloxane Pvp Pp Inject Soft Texture","code_information":[{"code":"7723813","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1479.0,"discounted_cash":591.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Needle Endo Macroplastique 3.8Frx14.5In 14Mm Tip Rigid Laser Mark Strl","code_information":[{"code":"7723814","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":57.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Rod Spinal Spherx Ii 5.5X50Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723815","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg24 - Pulls           G22636","code_information":[{"code":"7723816","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg Wide 11X26X14Mm Impacted Peek 4Deg","code_information":[{"code":"7723817","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12819.0,"discounted_cash":5127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-C 12X15.5X7Mm Self-Guided Self-Locking Standalone Peek-Optima Cervical Lordot","code_information":[{"code":"7723818","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6862.0,"discounted_cash":2744.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys 15X160Mm Primary Std Offst Collar Midcoat Tivanium Porous Fiber Metal Strt Lg","code_information":[{"code":"7723819","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":18568.0,"discounted_cash":7427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Reclaim 15X140Mm Cementls Revis Modul Collarls Ti Forged Strt Taper Dist Hip","code_information":[{"code":"7723820","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10880.0,"discounted_cash":4352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Reclaim 20X40Mm Offst 85Mm Cementls Revis Modul Ti Forged 135Deg Angle 12/14 Mini Taper","code_information":[{"code":"7723821","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13013.0,"discounted_cash":5205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-A Median 30X39X14Mm Tantalum Marker Peek-Optima 5.75Ml Lt1 Ant Lumb 10Deg Lordot","code_information":[{"code":"7723822","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16079.0,"discounted_cash":6431.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adapter Femur Head Hip","code_information":[{"code":"7723823","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":492.0,"discounted_cash":196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Centralizer Stem Versys 13Mm Cement Press-Fit Pmma Dist Femur Hip Strl","code_information":[{"code":"7723824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Versys Size 12 125Mm Cement Low Demand/Fracture Zimaloy 12/14 Taper Hip Strl","code_information":[{"code":"7723825","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6385.0,"discounted_cash":2554.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 44X66Mm +4 10Deg Angle Altrx","code_information":[{"code":"7723826","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6974.0,"discounted_cash":2789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur 44Mm Revis Modul Cocr","code_information":[{"code":"7723827","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9399.0,"discounted_cash":3759.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Anthology Med +8Mm Neck 12/14 Taper Primary Modul Head Ti Hip","code_information":[{"code":"7723828","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":376.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size C Cement Post Stabil Prolng Zimaloy Rt Lat Knee Strl","code_information":[{"code":"7723829","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15616.0,"discounted_cash":6246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Lead Neurostim Lamitrode Penta 1.4Mmx60Cm 3Mm Space 11X46Mm Paddle Implant 16-Electrode","code_information":[{"code":"7723830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":13424.0,"discounted_cash":5369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Vasc Archer 0.035Inx200Cm Sgl J-Tip Super Stiff Ptfe","code_information":[{"code":"7723831","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Graft Endovascular Endurant Stent Covered 32Mm P/D 49Mm Bifurc Closed Web Aortic Ext Cuff E Delivery","code_information":[{"code":"7723832","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13649.0,"discounted_cash":5459.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 32/16Mm P/D 166Mm Bifurc Preload Slf-Expand C","code_information":[{"code":"7723833","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":29755.0,"discounted_cash":11902.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 91Mm 2-Hole Contour Compress Lck Ss Limit-Cont Rt Prox Humeral Periarticular Strl","code_information":[{"code":"7723834","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5653.0,"discounted_cash":2261.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Biological Tissue Xcm 4X7Cm 1.5Mm Xenograft Porcine Dermal Collagen Matrix Non-Crosslinked","code_information":[{"code":"7723835","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2504.0,"discounted_cash":1001.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X110Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723836","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X90Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723837","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Implant Penile Titan Otr 16Cm Bioflex Silicone Inflate Onetouch Release Scrotal W/Cylinder","code_information":[{"code":"7723838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":21491.0,"discounted_cash":8596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Rappel Fine    86120103 Suture Q:12 Rappel Fine","code_information":[{"code":"7723839","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Expander Breast Siltex 12.7X10.8Cm 7Cm Contour-Profile 450Ml Silicone Gel Texture Bufferzone","code_information":[{"code":"7723840","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4649","type":"HCPCS"}],"standard_charges":[{"gross_charge":4475.0,"discounted_cash":1790.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast Memorygel Cohesive I 9.7Cm 4Cm Hp 200Ml Silicone Gel Smooth Ant Diaphragm Vlv","code_information":[{"code":"7723841","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Half Pin Extern Fixat 3X60Mm 10Mm Thread Self-Tapping/Drilling Apex Ss F/Thr Ns","code_information":[{"code":"7723842","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X65Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723843","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Darco 8Mm Step 1.5Mm Lck Open Wedge Ti Lat Rearfoot F/3.5Mm Screw Pia Evans Column","code_information":[{"code":"7723844","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5073.0,"discounted_cash":2029.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"K Wire 1.1Mm X 140   N02228012","code_information":[{"code":"7723845","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X16Mm Lck Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal Joint","code_information":[{"code":"7723846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco 3.5X24Mm Lck Full Thread Self-Tap Cortic Ti Hex Head 1St Tarsometatarsal Joint","code_information":[{"code":"7723847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Continuum Size Hh 50Mm Uni-Hole Hemis Snap-Fit Lck Groove Trabecul Metal Tivanium","code_information":[{"code":"7723848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8693.0,"discounted_cash":3477.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plug Acetabular Continuum Dome-Hole Trabecul Metal Tivanium Strl","code_information":[{"code":"7723849","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":110.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Continuum Size Hh 32X50Mm 4.7Mm Neutral Longevity Hxlpe Strl","code_information":[{"code":"7723850","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4460.0,"discounted_cash":1784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Kinectiv Size 5 109Mm Cementls Modul Ti 132Deg Angle Taper Medial Lat Hip","code_information":[{"code":"7723851","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19041.0,"discounted_cash":7616.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Neck Femur Kinectiv Size P1 12/14 Taper Ante/Retroverted Modul Cocr Hip Medial Lat","code_information":[{"code":"7723852","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5255.0,"discounted_cash":2102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2X18Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess Wrist Hand","code_information":[{"code":"7723853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 2X24Mm Compress Lck Full Thread Self-Tap Cortic Ss T6 Stardrive Recess Wrist Hand","code_information":[{"code":"7723854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":165.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 5X55Mm 3/7-Hole 1.3Mm Y-Shaped Compress Lck Lo-Pro Ss Reconstruct Condylar Ankle","code_information":[{"code":"7723855","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire #2 38In 1/2 Circ Taper Point Blue Black White Ar-7208 Arthro Braid Uhmwpe 26.5Mm","code_information":[{"code":"7723856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":41.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Fiberloop #2 20In Blue Ar-7234 Arthro W/Straight Needle Nonabsorbable","code_information":[{"code":"7723857","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Suture Tigerloop Tigerwire #2 20In Strt Loop White Green Ar-7234T Arthro Braid Polyblend 76X7Mm","code_information":[{"code":"7723858","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":84.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bolt Inter Fixat Graftbolt 9Mm Cannul Biocomposite Peek Tibial W/Screw Sheath","code_information":[{"code":"7723859","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":472.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Button Suture Tightrope Rt Ti Uhmwpe 4-Point Lck Lf Arthro Adjust Loop F/Acl Reconstruct","code_information":[{"code":"7723860","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Wide 10X22X50Mm Expand Tooth Peek Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7723861","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16450.0,"discounted_cash":6580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg Wide 11X26X13Mm Impacted Peek 4Deg","code_information":[{"code":"7723862","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12819.0,"discounted_cash":5127.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X45Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723863","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Spherx Ii 5.5X40Mm Curve Pre-Bent Ball Ti","code_information":[{"code":"7723864","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 98Mm 8-Hole Lg Strt Lck Lo-Pro Ti Std Rt Midshaft Clavicle Ns","code_information":[{"code":"7723865","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3866.0,"discounted_cash":1546.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Polarus 3.5X32Mm Lck Full Thread Cortic Ti Blue Elbow Clavicle F/Mayo Modul Univ Plate","code_information":[{"code":"7723866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Acetabular Pinnacle 62/64Mm 10Mm Buttress Revis Gription Ti Foam Strl","code_information":[{"code":"7723867","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":2816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 64Mm Multi-Hole Bantam Primary Gription W/6.5Mm Dome Screw","code_information":[{"code":"7723868","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8437.0,"discounted_cash":3374.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 44X64Mm +4 10Deg Angle Altrx","code_information":[{"code":"7723869","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6974.0,"discounted_cash":2789.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 44Mm +5Mm Neck 12/14 Taper Modul Biolox Delta Ts","code_information":[{"code":"7723870","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6950.0,"discounted_cash":2780.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X62Mm +4 Neutral Marathon","code_information":[{"code":"7723871","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4773.0,"discounted_cash":1909.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Explant Blade Small 7053-60-10 Small 60Mm Acetabular Blade","code_information":[{"code":"7723872","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3133.0,"discounted_cash":1253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Explant Blade Large 7053-60-20 Large 60Mm Acetabular Blade","code_information":[{"code":"7723873","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3133.0,"discounted_cash":1253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Sigma Size 2 Cement Post Stabil Modul Tricompart Cocr Porous Rt Strl","code_information":[{"code":"7723874","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9457.0,"discounted_cash":3782.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial P.F.C Sigma Size 2 61Mm/39Mm 12.5Mm Post Stabil Tricompart Rotat Platform Gvf Pe","code_information":[{"code":"7723875","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4731.0,"discounted_cash":1892.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Adhesive Skin Close Premierpro Exofin 1Ml High Viscos Precision Pen Applicator Flex 2-Octyl","code_information":[{"code":"7723876","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Roi-A Median 30X39X10Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 6Deg Lordot Yellow","code_information":[{"code":"7723877","type":"CDM"}],"standard_charges":[{"gross_charge":16079.0,"discounted_cash":6431.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Set Catheter Hemodialysis Arrow Nextstep Chronic 15Frx23Cm 23Cm High Flow Antegrad Pur Step/Split","code_information":[{"code":"7723879","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Ext S-Rom Noiles 12Mm Univ 75Mm Cement Modul Flute Rotat Hinge Cocr Knee Strl","code_information":[{"code":"7723881","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4163.0,"discounted_cash":1665.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Lps-Flex Size D Cement Post Stabil Prolng Zimaloy Lt Lat Knee Strl","code_information":[{"code":"7723882","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15616.0,"discounted_cash":6246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Catheter Angiographic Performa 5Frx125Cm Jr4 Wing Hub Pebax Nylon 0.038In Gw","code_information":[{"code":"7723884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ring Acetabular Duraloc 52Mm Bantam Dynamic Lck Pe","code_information":[{"code":"7723885","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Duraloc 32X52Mm Cementls 10Deg Angle Lat Marathon","code_information":[{"code":"7723886","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4495.0,"discounted_cash":1798.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Solution System 13.5Mmx8In Cementls Lg Stature Cocr Porocoat 12/14 Taper Strt","code_information":[{"code":"7723887","type":"CDM"}],"standard_charges":[{"gross_charge":21485.0,"discounted_cash":8594.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Xwide 12X26X55Mm Peek","code_information":[{"code":"7723888","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17243.0,"discounted_cash":6897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Helical Blade 95Mm    456.304S","code_information":[{"code":"7723889","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":842.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X90Mm Cannul Helical Solid Ti Femur Gold Strl","code_information":[{"code":"7723890","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2253.0,"discounted_cash":901.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Sigma Size 4 Cement Post Stabil Modul Tricompart Cocr Porous Lt Strl","code_information":[{"code":"7723891","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8596.0,"discounted_cash":3438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur P.F.C Sigma Size 4 4Mm Wedge/Block Cement Combo Post Knee Strl Disp","code_information":[{"code":"7723892","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2565.0,"discounted_cash":1026.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Sigma Size 3 Cement Post Stabil Modul Tricompart Cocr Porous Lt Strl","code_information":[{"code":"7723893","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8596.0,"discounted_cash":3438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Reclaim 24X45Mm Offst 75Mm Cementls Revis Modul Ti Forged 135Deg Angle 12/14 Mini Taper","code_information":[{"code":"7723894","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11829.0,"discounted_cash":4731.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Reclaim 18X140Mm Cementls Revis Modul Collarls Ti Forged Strt Taper Dist Hip","code_information":[{"code":"7723895","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9891.0,"discounted_cash":3956.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 40Mm +8.5Mm Neck 12/14 Taper Contour Modul M-Specification Cocr Hip","code_information":[{"code":"7723896","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4618.0,"discounted_cash":1847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Prodigy 18Mm Hip W/Redux","code_information":[{"code":"7723897","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12811.0,"discounted_cash":5124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Implant Toe Joint Nextra 3.2Mm Prox Middle Phalangeal W/1.6/2.8/3.5Mm Step Drill Reamer Bone","code_information":[{"code":"7723898","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2972.0,"discounted_cash":1188.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Implant Toe Joint Nextra Size 4.5/3.2Mm 10Deg Angle 2Pc Precision Insertion Reversible Ss Prox","code_information":[{"code":"7723899","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2972.0,"discounted_cash":1188.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Nextra 3.5/3.2Mm Middle Prox Phalangeal Strl","code_information":[{"code":"7723900","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2159.0,"discounted_cash":863.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Toe Joint Nextra 4.5/3.2Mm Phalangeal F/Hammertoe Correct System Strl","code_information":[{"code":"7723901","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2159.0,"discounted_cash":863.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Arthro Cpr Mini Scorpion Dx W/Ndl Suturelasso Lt/Rt #0 Fiberwire 97Cm Suturetape 2X11/2X13Mm","code_information":[{"code":"7723902","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2578.0,"discounted_cash":1031.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl 8X22X60Mm Expand Tooth Peek Extreme Lat Thoracolum","code_information":[{"code":"7723903","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14957.0,"discounted_cash":5982.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Xpode 2.4X14Mm Compress Lck Pink Ns","code_information":[{"code":"7723904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Xpode 2.4X12Mm Compress Lck Pink Ns","code_information":[{"code":"7723905","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Xpode 2.4X10Mm Compress Lck Pink Ns","code_information":[{"code":"7723906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 0.8X120Mm Kirschner Temp","code_information":[{"code":"7723907","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":21.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Reamer Xpode 18Mm F/Subtalar Fusion Cup System C180901","code_information":[{"code":"7723908","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Arthro Tightrope Plus Knotless Ss Lf Strl Disp F/Syndesmosis Repair","code_information":[{"code":"7723909","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2306.0,"discounted_cash":922.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Half 180Mm Ilizarov Taylor Spatial Frame Alum F/Foot Ankle System Pvc-Free","code_information":[{"code":"7723910","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4096.0,"discounted_cash":1638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Germicid Acticoat Exfix Sponge 6X10In Antimic Absorb Nanocrystal Silver Strl 10/Bx","code_information":[{"code":"7723911","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Clip Extern Fixat Disc Ilizarov F/1.5-1.8Mm Wire Ns Reus 30/Bx","code_information":[{"code":"7723912","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 5.5Mm Qck-Conn Cannul Disp","code_information":[{"code":"7723913","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Ring Extern Fixat Rocker 155Mm Ilizarov Taylor Spatial Frame Alum Strl","code_information":[{"code":"7723914","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3162.0,"discounted_cash":1264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent 14X26X55Mm Peek 10Deg","code_information":[{"code":"7723915","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":6270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Pinnacle 36X64Mm Neutral Altrx","code_information":[{"code":"7723917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3676.0,"discounted_cash":1470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Stem Femur Corail Size 18 180Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723918","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13703.0,"discounted_cash":5481.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-A Median 30X39X16Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 10Deg Lordot Yellow","code_information":[{"code":"7723919","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14618.0,"discounted_cash":5847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Roi-A Sm Short +0.5Mm Lck Load Ti Ant Lumb F/Anchoring","code_information":[{"code":"7723920","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8509.0,"discounted_cash":3403.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc 230Mm 10-Hole Contour Scallop Lck Ss Lt Lat Dist Femur F/4.5Mm Screw","code_information":[{"code":"7723921","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5424.0,"discounted_cash":2169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X46Mm Non-Locking Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute","code_information":[{"code":"7723922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Locking 46Mm    73827046","code_information":[{"code":"7723923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 4.5X70Mm Lck Self-Tap Cortic Ss T25 Drive Periarticular Cut 3-Flute F/Large Frag","code_information":[{"code":"7723924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Locking 40Mm    73827040","code_information":[{"code":"7723925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X42Mm Non-Locking Self-Tap Cortic Ss T20 Stardrive Recess Periarticular Cut","code_information":[{"code":"7723926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X38Mm Non-Locking Self-Tap Cortic Ss T20 Stardrive Recess Periarticular Cut","code_information":[{"code":"7723927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc 3.5X20Mm Non-Locking Self-Tap Cortic Ss T20 Stardrive Recess Periarticular Cut","code_information":[{"code":"7723928","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Hgp Ii Size E 28Mm Compo 0Deg Angle Primary Elevated Longevity Xl Uhmwpe Strl","code_information":[{"code":"7723929","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5534.0,"discounted_cash":2213.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Ringloc 28Mm Med +10.5Mm Neck 6Deg Angle Taper Anatomic Cocr Hip Strl","code_information":[{"code":"7723930","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2826.0,"discounted_cash":1130.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Needle Endo Injetak Cystoscopy 23Ga 35Cm Adjust Tip F/Protox Strl","code_information":[{"code":"7723931","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Coroent 16X22X60Mm Peek 10Deg","code_information":[{"code":"7723932","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14957.0,"discounted_cash":5982.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Corail Size 20 190Mm Cementls Lo-Pro Collar Std Offst Ti Hap 135Deg Angle 12/14 Taper","code_information":[{"code":"7723933","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":13703.0,"discounted_cash":5481.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 56Mm Unipol Modul Cathcart Ball Orthocentric Hip F/Fracture","code_information":[{"code":"7723934","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1031.0,"discounted_cash":412.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Reclaim 19X140Mm Cementls Revis Modul Collarls Ti Forged Strt Taper Dist Hip","code_information":[{"code":"7723935","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9891.0,"discounted_cash":3956.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Femur Reclaim 28X45Mm Offst 85Mm Cementls Revis Modul Ti Forged 135Deg Angle 12/14 Mini Taper","code_information":[{"code":"7723936","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11829.0,"discounted_cash":4731.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg 9X26X10Mm Impacted Peek 4Deg Narrow","code_information":[{"code":"7723937","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11653.0,"discounted_cash":4661.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Hps 3X16Mm Cannul Headless Self-Drilling/Tapping Solid Core Ti Hand F/Complex Frx Ns","code_information":[{"code":"7723938","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Pacemaker Cardiac Invive Implant 1.75X2.4In 0.3In 34G 15Ml Biventric 2-Chamber Rate Respons","code_information":[{"code":"7723939","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":40662.0,"discounted_cash":16264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Articul/Eze 36Mm +12Mm Neck 12/14 Taper Modul Biolox Delta Ts Hip","code_information":[{"code":"7723940","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4257.0,"discounted_cash":1702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Peri-Loc 5Mm Cannul Qck-Conn Calib F/6.5Mm Screw","code_information":[{"code":"7723941","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1653.0,"discounted_cash":661.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lg 6.5X55Mm Cannul 22Mm Partial Thread Self-Drilling/Tapping Ti Hex Drive Revers Cut","code_information":[{"code":"7723942","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":402.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lg 6.5X60Mm Cannul 22Mm Partial Thread Self-Drilling/Tapping Ti Hex Drive Revers Cut","code_information":[{"code":"7723943","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.0,"discounted_cash":402.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho 12.7Mm Round Ti Strl","code_information":[{"code":"7723944","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":60.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acutrak 2 2Mm Micro 18Mm Cannul Compress Headless Full Wide Thread Self-Tapping/Cutting","code_information":[{"code":"7723945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":624.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Acutrak 2 1.9Mm Micro Long 34Mm","code_information":[{"code":"7723946","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":795.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Block Bone Graft Osteosponge 12X12X12Mm Allograft Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7723947","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1386.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Block Bone Graft Osteosponge 14X14X14Mm Allograft Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7723948","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1844.0,"discounted_cash":737.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Osteosponge 20X50X7Mm Allograft Syringe Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7723949","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6294.0,"discounted_cash":2517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Osteosponge 15X40X5Mm Allograft Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7723950","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4881.0,"discounted_cash":1952.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Strip Bone Graft Osteosponge 10X50X7Mm Allograft Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7723951","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3227.0,"discounted_cash":1290.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size H Lt","code_information":[{"code":"7723952","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15485.0,"discounted_cash":6194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-A Median 27X36X14Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 10Deg Lordot Green","code_information":[{"code":"7723953","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14618.0,"discounted_cash":5847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Arthro W/Metal Spear Drill Lf Disp F/2.9Mm Knotless Pushlock Rotator Cuff Fixat","code_information":[{"code":"7723954","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":271.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Suture Bio-Pushlock Knotless 2.9X15.5Mm Absorb Closed Eyelet Labral Plla Mri-Safe","code_information":[{"code":"7723955","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":528.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Spinal Roi-A Long Lck Load Ti Ant Lumb F/Anchoring","code_information":[{"code":"7723956","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8509.0,"discounted_cash":3403.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Optetrak Logic Size 3 Cement Cylindr Post Stabil Rt","code_information":[{"code":"7723957","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19932.0,"discounted_cash":7972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Tibial Optetrak Logic Size 3F/2T Cement Finned Fit Knee Strl","code_information":[{"code":"7723958","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10157.0,"discounted_cash":4062.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Optetrak 29Mm 3-Peg Pe","code_information":[{"code":"7723959","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":1362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Optetrak Logic Size 3 11Mm Modul Post Stabil Pe","code_information":[{"code":"7723960","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6483.0,"discounted_cash":2593.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Washer Ortho 6.5Mm Round Thread Ss Ns","code_information":[{"code":"7723961","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":65.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cable Ortho Cable-Ready 1.8Mm Long 635Mm Grip System Cocr Greater Trochan F/Trauma Strl","code_information":[{"code":"7723962","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Nexgen 38Mm Std 10Mm Primary Press-Fit Trabecul Metal Pmma Porous W/O X-Ray Wire","code_information":[{"code":"7723963","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6141.0,"discounted_cash":2456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Nexgen Legacy Size G Post Stabil Flexion Porous Rt","code_information":[{"code":"7723964","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17244.0,"discounted_cash":6897.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Nexgen Mis Size 8 Modul Fixed Bearing Stemmed Trabecul Metal Porous Knee","code_information":[{"code":"7723965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9367.0,"discounted_cash":3746.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Darco 1.5Mm Lck Ti Lat Rearfoot F/3.5Mm Screw Pia Evans Column Lengthening","code_information":[{"code":"7723966","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4614.0,"discounted_cash":1845.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Darco Lck","code_information":[{"code":"7723967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Dart Headed    Din30040S 3.0 X 40 Mm Dart Fire Screw","code_information":[{"code":"7723968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":253.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire 2X20Mm Headed Ti","code_information":[{"code":"7723969","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 2X16Mm Cannul Compress Headed Partial Thread Self-Drilling/Tapping Ti T8","code_information":[{"code":"7723970","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Equinoxe 13Mm Cementls Trapezoid Cylindr Primary Press-Fit Flute Ti Prox Dist Strl","code_information":[{"code":"7723971","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9222.0,"discounted_cash":3688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Glenoid Fixat Equinoxe Med Pegged Beta Uhmwpe F/Shoulder Arthropl Strl","code_information":[{"code":"7723972","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6686.0,"discounted_cash":2674.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Equinoxe 4.5Mm Offst +/-7.5Deg Neck 125-140Deg Angle Ti Anatomic Replicator Humeral Strl","code_information":[{"code":"7723973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4530.0,"discounted_cash":1812.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Screwdriver Surg Equinoxe Lck Square Revers Torq Defining W/Replicator Plate Strl","code_information":[{"code":"7723974","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1265.0,"discounted_cash":506.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Humeral Equinoxe 47Mm Short 1.5Mm Offst 18Mm Beta Cocr Strl","code_information":[{"code":"7723975","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7025.0,"discounted_cash":2810.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Equinoxe 1.5Mm Offst +/-7.5Deg Neck 125-140Deg Angle Ti Anatomic Replicator Humeral Strl","code_information":[{"code":"7723976","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7025.0,"discounted_cash":2810.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Equinoxe 11Mm Cementls Trapezoid Cylindr Primary Press-Fit Flute Ti Prox Dist Strl","code_information":[{"code":"7723977","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9222.0,"discounted_cash":3688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Head Humeral Equinoxe 41Mm Short 1.5Mm Offst 16Mm Alpha Cocr Strl","code_information":[{"code":"7723978","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7025.0,"discounted_cash":2810.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Self-Centering 28X56Mm Bipol Modul Cup Ball Cocr Hip Blue","code_information":[{"code":"7723979","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":892.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Kit Prosthesis Penile Titan Std 10-22Cm Bioflex Silicone Hydrphil Coat Inflate Onetouch Release","code_information":[{"code":"7723980","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":9878.0,"discounted_cash":3951.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Prosthesis Penile Titan 18Cm Bioflex Silicone Cylindr Strl","code_information":[{"code":"7723981","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1283.0,"discounted_cash":513.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Anchor Neurostim Swift-Lock Lck Mech Lead Spinal Cord","code_information":[{"code":"7723982","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 88Mm 8-Hole Strt Lck Lo-Pro Ti Lt Midshaft Clavicle Ns","code_information":[{"code":"7723983","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3514.0,"discounted_cash":1405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 2.7X16Mm Non-Locking Cortic Ti Hex Drive Blue Elbow Clavicle F/Mayo Lck","code_information":[{"code":"7723984","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidewire Ortho Acutrak 0.062In 6In Sgl Trocar Tip Ss F/K-Wire Position Ns","code_information":[{"code":"7723985","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":160.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Fixator Extern Fixat Lo-Pro Wrist W/4/2.5Mm Schanz 200Mm Carbon Fiber Rod Mri-Safe Strl","code_information":[{"code":"7723986","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3905.0,"discounted_cash":1562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-A Median 27X36X14Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 14Deg Lordot Green","code_information":[{"code":"7723987","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14618.0,"discounted_cash":5847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lcp 109Mm 4-Hole Pre-Contoured Low Bend Compress Lck Ss Rt Dist Medial Tibial F/3.5Mm","code_information":[{"code":"7723988","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":5005.0,"discounted_cash":2002.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Lcp 6.5X45Mm Cannul Compress Lck 32Mm Thread Self-Drilling/Tapping Cortic Ss Hex Socket","code_information":[{"code":"7723989","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-C 14X15.5X7Mm Self-Guided Self-Locking Standalone Peek-Optima Cervical Lordot","code_information":[{"code":"7723990","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6238.0,"discounted_cash":2495.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Dressing Foam Mepilex Border Ag Slf-Adher Post-Op 4X6In Contact Layer Antimic Absorb Conform Silver","code_information":[{"code":"7723991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Dressing Foam Mepilex Border Ag Slf-Adher Post-Op 4X10In Contact Layer Antimic Absorb Conform Silver","code_information":[{"code":"7723992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Aquacel Dressing 3.5X14 412012","code_information":[{"code":"7723993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Glenoid Fixat Equinoxe Sm Pegged Alpha Uhmwpe F/Shoulder Arthropl Strl","code_information":[{"code":"7723994","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6686.0,"discounted_cash":2674.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Stem Humeral Equinoxe 7.5Mm Cementls Trapezoid Cylindr Primary Press-Fit Flute Ti Prox Dist Strl","code_information":[{"code":"7723995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9222.0,"discounted_cash":3688.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Filler Bone Graft Osteosponge 4-10Mm Chips Allograft 1Ml Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7723996","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Filler Bone Graft Osteosponge 4-10Mm Chips Allograft 15Ml Cancell Dbm Ambient Store 5Yr Shelf Life","code_information":[{"code":"7723997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3113.0,"discounted_cash":1245.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Putty Bone Graft Osteoselect Allograft 1Ml Jar Dbm","code_information":[{"code":"7723998","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Legion Size 7-8 11Mm Artic Surface Post Stabil High Flexion Xlpe Strl","code_information":[{"code":"7723999","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8596.0,"discounted_cash":3438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 2.7X14Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ss T10 Hexalobe Drive Wrist Hand","code_information":[{"code":"7724000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 2.7X16Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ss T10 Hexalobe Drive Wrist Hand","code_information":[{"code":"7724001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X14Mm Non-Locking Full Thread Self-Drill Lo-Pro Cortic Ss T15 Hexalobe Drive Clavicle","code_information":[{"code":"7724002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X12Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ss T15 Hexalobe Drive Wrist Hand","code_information":[{"code":"7724003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"One Step Button Low Profile                           6301","code_information":[{"code":"7724004","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":198.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X16Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ss T15 Hexalobe Drive Wrist Hand","code_information":[{"code":"7724005","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Plate Bone Tightrope 91Mm 5-Hole Buttress Lck Ss Lt Dist Fibula F/Syndesmosis Repair Ns","code_information":[{"code":"7724006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1763.0,"discounted_cash":705.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur Size 5 Lt","code_information":[{"code":"7724007","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19932.0,"discounted_cash":7972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Tibial Optetrak Logic Size 5F/5T Cement Finned Fit Knee Strl","code_information":[{"code":"7724008","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10157.0,"discounted_cash":4062.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Optetrak Logic Size 5 9Mm Modul Post Stabil Pe","code_information":[{"code":"7724009","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6483.0,"discounted_cash":2593.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Tibial Mbt Lcs Complete 37Mm 40Mm Metaphyseal Knee Modul Revis Tray Pe Porous F/Lps","code_information":[{"code":"7724010","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6612.0,"discounted_cash":2644.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Patellar Lcs Complete Standard+ Cementls 3-Peg Replace Rotat Pe Metal","code_information":[{"code":"7724011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1886.0,"discounted_cash":754.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone 48Mm 3-Hole Std Contour 7-Peg Ss Fixed Angle Rt Volar Wrist Ns","code_information":[{"code":"7724012","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2267.0,"discounted_cash":906.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Twist 1.75Mm Chuck End","code_information":[{"code":"7724013","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Torx 2.3X20Mm Screw Lck Perm Thread Ss Volar","code_information":[{"code":"7724014","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat Torx 20Mm Perm Non-Threaded Ss Volar","code_information":[{"code":"7724015","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.2X13Mm Thread Cortic Ss Hex Head Clavicle Wrist Ankle Ns","code_information":[{"code":"7724016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Surgibit 2.3Mm Long 5In Fore Midfoot Qr","code_information":[{"code":"7724018","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":131.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X28Mm Lck Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate System Ns","code_information":[{"code":"7724019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3.5X12Mm Lck Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate System Ns","code_information":[{"code":"7724020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Acu-Loc 2 3X18Mm Non-Locking Ti Hexalobe Dist Humeral Elbow Ankle Wrist F/Total Plate","code_information":[{"code":"7724021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 Narrow Lck Ti Var Ang Rt Extraarticular Prox Dist Volar Radial Wrist Ns","code_information":[{"code":"7724022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":1362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Cage Spinal Coroent Xl Wide 8X22X60Mm Expand Tooth Peek Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7724023","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14957.0,"discounted_cash":5982.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Hood Surg Helmet Steri-Shield Flyte Lf Fabric Strl Disp","code_information":[{"code":"7724024","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg Wide 11X32X14Mm Impacted Peek 4Deg","code_information":[{"code":"7724025","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":11653.0,"discounted_cash":4661.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Tightrope 98Mm 8-Hole 1/3 Tubul Lck Ss Central 3Rd Ankle Foot Deltoid Ligament","code_information":[{"code":"7724026","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X16Mm Non-Locking Full Thread Self-Drill Lo-Pro Cortic Ss T15 Hexalobe Drive Clavicle","code_information":[{"code":"7724027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X14Mm Lck Full Thread Self-Drill Lo-Pro Cortic Ss T15 Hexalobe Drive Wrist Hand","code_information":[{"code":"7724028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Arthro 2.5X30Mm Ss Ankle Cannul Ao Shaft Calib Grad Lf Strl Disp F/2.7/3Mm Screw Frx","code_information":[{"code":"7724029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Bit Drill Arthro 2.5Mm Ss Humeral Cannul Ao Shaft Calib Grad Lf Strl Disp F/Suture Plate","code_information":[{"code":"7724030","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spacer Spinal Coroent Xl Xwide 8X26X60Mm Peek","code_information":[{"code":"7724031","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":6270.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cup Acetabular Pinnacle 64Mm 3-Hole Primary Sector Gription","code_information":[{"code":"7724032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5749.0,"discounted_cash":2299.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-A Median 30X39X16Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 6Deg Lordot Yellow","code_information":[{"code":"7724033","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14618.0,"discounted_cash":5847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Acu-Loc 2 Bevel Edge Lck Ti Std Rt Prox Dist Volar Radial Ns","code_information":[{"code":"7724034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.0,"discounted_cash":1362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Component Femur P.F.C Sigma Tc3 Size 2.5 63/59Mm Cement Post Stabil C/S Revis Cocr Non-Porous Lt","code_information":[{"code":"7724035","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14942.0,"discounted_cash":5976.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Component Tibial S-Rom Noiles Size 2 64.6/42.6Mm 4.8Mm Cement Post Stabil Tricompart Revis","code_information":[{"code":"7724036","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12029.0,"discounted_cash":4811.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Lcs Complete Univ 31Mm Cntr Ti Full Porous Knee","code_information":[{"code":"7724037","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7586.0,"discounted_cash":3034.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Sigma Tc3 Size 2.5 67Mm/45Mm 15Mm Post Stabil Rotat Platform Uhmwpe","code_information":[{"code":"7724038","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6461.0,"discounted_cash":2584.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Acp Dbl Syringe    Abs-100-10S","code_information":[{"code":"7724039","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Legion Size 3-4 15Mm Artic Surface Post Stabil High Flexion Xlpe Strl","code_information":[{"code":"7724040","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8247.0,"discounted_cash":3298.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Dart-Fire Sm 2.5X32Mm Cannul Compress Headless Partial Thread Self-Drilling/Tapping Ti","code_information":[{"code":"7724041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Xwide 10X26X55Mm Peek Lordot","code_information":[{"code":"7724042","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14238.0,"discounted_cash":5695.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Wide 14X22X50Mm Peek Lordot","code_information":[{"code":"7724043","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":16271.0,"discounted_cash":6508.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Coroent Xl-F 6.5X45Mm Var Ang Ti","code_information":[{"code":"7724044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1763.0,"discounted_cash":705.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Picc Bioflo Mst 5Frx55Cm 2Lumen Revers Taper Pasv Vlv Power Inject Trim W/70Cm Nt Ptfe","code_information":[{"code":"7724046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc Vlp 86Mm 7-Hole 1.5Mm Contour Lck Ss Var Ang Rt Post/Lat Dist Fibula F/3.5Mm","code_information":[{"code":"7724047","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1979.0,"discounted_cash":791.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X12Mm Lck Full Thread Self-Tap Std Cortic Ss Hex Recess Head 15Deg Angle","code_information":[{"code":"7724048","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":160.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X30Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7724049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":172.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Ncb Lg 5X34Mm Lck Dbl Lead Thread Polyaxial Self-Tap Bicortical Protasul-64 3.5Mm Hex","code_information":[{"code":"7724050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.0,"discounted_cash":172.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"9.6Fi Preattached      1859660","code_information":[{"code":"7724051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1814.0,"discounted_cash":725.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Roi-C 14X17X5Mm Self-Guided Self-Locking Standalone Peek-Optima Cervical Lordot Color-Cd","code_information":[{"code":"7724053","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6238.0,"discounted_cash":2495.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Breast 14.9-15.6Cm 4.9-5.8Cm Moderate-Profile 700-775Ml Saline-Filled Smooth Ant Diaphragm","code_information":[{"code":"7724054","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":679.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur S-Rom Noiles Xs Sm Med 10Mm Wedge/Block Rotat Hinge Dist Knee","code_information":[{"code":"7724055","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1992.0,"discounted_cash":796.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur S-Rom Noiles Sm 66/62Mm Cement Post Stabil Modul Rotat Hinge Cocr Lt W/Pin","code_information":[{"code":"7724056","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":15898.0,"discounted_cash":6359.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Lps Sm Univ 12Mm Flat Modul Hinge Forged Cocr","code_information":[{"code":"7724057","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6812.0,"discounted_cash":2724.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Asphere 36Mm +12Mm Neck 12/14 Taper Modul M-Specification Ball Cocr Hip","code_information":[{"code":"7724058","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2496.0,"discounted_cash":998.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cage Spinal Coroent Xl Wide 12X22X50Mm Expand Tooth Peek Extreme Lat Thoracolum 10Deg Lordot","code_information":[{"code":"7724059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11932.0,"discounted_cash":4772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Journey Size 3 Unicompart Lt Medial Rt Lat","code_information":[{"code":"7724060","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7826.0,"discounted_cash":3130.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Saw Hall M-Class Oscillat 19X90Mm 1.27Mm Coarse Middle/Beveled Center/Fine Outer Tooth","code_information":[{"code":"7724061","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":67.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Oscillating Blade  T193-119-90 1.19Mm","code_information":[{"code":"7724062","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":73.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extraction Basket   Fl-Lxb-3X6 3Cm X 6Cm","code_information":[{"code":"7724063","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":904.0,"discounted_cash":361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Extraction Basket   Fs-Lxb-2X4 2Cm X 4Cm","code_information":[{"code":"7724064","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":741.0,"discounted_cash":296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Ceramax 28X56Mm Neutral Ceramic","code_information":[{"code":"7724065","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10113.0,"discounted_cash":4045.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Implant Laryngeal Radiesse Voice Calcium Ha 1Ml Syringe Gel Short Acting","code_information":[{"code":"7724066","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Allograft Human Tissue Graftjacket 1X12Cm 1.5Mm Regen Max Force Acell Dermal Matrix","code_information":[{"code":"7724067","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6021.0,"discounted_cash":2408.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Suture Fiberwire 2-0 18In 3/8 Circ T-13 Tapercut Blue Ar-7220 Arthro Braid Uhmwpe 17.9Mm","code_information":[{"code":"7724068","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone Expert 5X50Mm Lck Fully/Double Lead Thread Self-Tapping/Cutting Cortic Ti Hex Recess","code_information":[{"code":"7724069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Expert 5X44Mm Lck Fully/Double Lead Thread Self-Tapping/Cutting Cortic Ti Hex Recess","code_information":[{"code":"7724070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Nail Im Tfn-Advanced 11Mm Long 360Mm 130Deg Angle Dynamic Cannul Static Interlocking Preassembled Rt","code_information":[{"code":"7724071","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6217.0,"discounted_cash":2486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Blade Im Nail Tfn-Advanced 11X85Mm Cannul Helical Solid Ti Femur Gold Ns","code_information":[{"code":"7724072","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2090.0,"discounted_cash":836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Quickfix 4X42Mm Cannul Compress Headless Short Thread Self-Drilling/Tapping Lo-Pro","code_information":[{"code":"7724073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 4.5X40Mm Cannul Partial Thread Lo-Pro Cortic Ti T15 Hexalobe Drive Black Wrist Hand","code_information":[{"code":"7724074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.7X85Mm Cannul 18Mm Partial Thread Self-Drilling/Tapping Lo-Pro Cancell Ti Clavicle","code_information":[{"code":"7724075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 6.7X90Mm Cannul 18Mm Partial Thread Self-Drilling/Tapping Lo-Pro Cancell Ti Clavicle","code_information":[{"code":"7724076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Arthro 0.094X8In Trocar Tip F/6.7Mm Screw Lf Disp - D","code_information":[{"code":"7724077","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Arthro Quickfix 1.35Mm Cannul Laser Line Trocar Tip Ss Lf Strl Disp","code_information":[{"code":"7724078","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 25/16Mm P/D 145Mm Bifurc Preload Slf-Expand C","code_information":[{"code":"7724079","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":27050.0,"discounted_cash":10820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 16/20Mm P/D 156Mm Bifurc Preload Slf-Expand","code_information":[{"code":"7724080","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":17355.0,"discounted_cash":6942.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Graft Endovascular Endurant Ii Stent Covered 16Mm P/D 93Mm Bifurc Preload Slf-Expand","code_information":[{"code":"7724081","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":12611.0,"discounted_cash":5044.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Natural Nail 4.3X152.5Mm Dist Targeting Freehand Ss Ns","code_information":[{"code":"7724082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Putty Bone Graft Beta-Bsm 5Ml Fast-Set Inject Dbm Nanocrystal Cahpo4 3-5Min Set Time","code_information":[{"code":"7724083","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":7846.0,"discounted_cash":3138.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Spacer Spinal Coroent Lg 9X26X13Mm Impacted Peek 4Deg Narrow","code_information":[{"code":"7724084","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10306.0,"discounted_cash":4122.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X30Mm Cannul Partial Thread Lo-Pro Cortic Ti T15 Hexalobe Drive Black Wrist Hand","code_information":[{"code":"7724085","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"6.7 X 70 Screw    Ar-8967-1870","code_information":[{"code":"7724086","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Tightrope 131Mm 10-Hole 1/3 Tubul Lck Ss Central 3Rd Ankle Foot Deltoid Ligament","code_information":[{"code":"7724087","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":304.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 2.6Mm Cervical Cannul Ao Shaft Calib Grad Lf Strl Disp F/2.7/3Mm Screw Frx Manage","code_information":[{"code":"7724088","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Guidewire Arthro 1.35X130Mm Thread Trocar Tip Lf Strl","code_information":[{"code":"7724089","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.42,"discounted_cash":35.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Process Pack 30Ml        51404","code_information":[{"code":"7724090","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Peri-Loc Vlp 86Mm 7-Hole 1.5Mm Contour Lck Ss Var Ang Lt Post/Lat Dist Fibula F/3.5Mm","code_information":[{"code":"7724091","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2230.0,"discounted_cash":892.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X22Mm Cannul 9Mm Partial Thread Self-Tap Std Ss Hex Drive Socket Spheric Head Supracond","code_information":[{"code":"7724092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Guidepin Ortho 1.3Mm 140Mm Thread Trocar Point F/4X5Mm Cannul Screw Strl - D","code_information":[{"code":"7724093","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Drill Bit Cannulated    117066 Cannulated Drill Bit","code_information":[{"code":"7724094","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1623.0,"discounted_cash":649.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw N Locking 10Mm  71821310 10Mm Non Locking Screw","code_information":[{"code":"7724095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Peri-Loc Vlp 3.5X8Mm Lck Full Thread Self-Tap Std Cortic Ss Hex Recess Head 15Deg Angle","code_information":[{"code":"7724096","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":181.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Legion Size 5-6 13Mm Artic Surface Post Stabil High Flex Xlpe","code_information":[{"code":"7724097","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":8247.0,"discounted_cash":3298.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Armada 6.5X40Mm Polyaxial Ti F/5.5Mm Rod","code_information":[{"code":"7724098","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2441.0,"discounted_cash":976.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Spinal Armada Lck Ti Open Tulip Head Post Thoracolum","code_information":[{"code":"7724099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Armada 5.5X60Mm Pre-Bent Convent Ti Arm15T","code_information":[{"code":"7724100","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":458.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Rod Spinal Armada 5.5X65Mm Pre-Bent Convent Ti Arm15T","code_information":[{"code":"7724101","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1263.0,"discounted_cash":505.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Cross Connector Spinal Armada 45-50Mm Ti F/5.5Mm Rod","code_information":[{"code":"7724102","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3726.0,"discounted_cash":1490.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sling Gyn Bioarc Sp","code_information":[{"code":"7724103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":4624.0,"discounted_cash":1849.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Acetabular Omnifit Series Ii 32X58Mm 10Deg Angle Revis Crossfire","code_information":[{"code":"7724104","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3352.0,"discounted_cash":1340.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Sleeve Femur Trident Univ +0Mm Neck Adapt C-Tapered Ti Hip","code_information":[{"code":"7724105","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":531.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Head Femur Trident 32Mm Univ +0Mm Neck Taper Primary Modul Anatomic Biolox Delta Hip","code_information":[{"code":"7724106","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":4432.0,"discounted_cash":1772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Defibrillator Cardiac Energen Implant 6.17X6.90X0.99Cm 30.5Ml 72Gm Rt Ventric Single-Chamber","code_information":[{"code":"7724107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":47455.0,"discounted_cash":18982.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2Mm Quick-Coupling","code_information":[{"code":"7724108","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill 2.5Mm Anc089","code_information":[{"code":"7724109","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Activ Ankle 2.8X18Mm Lck Green Anodized","code_information":[{"code":"7724110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Activ Ankle 2.8X20Mm Lck Green Anodized","code_information":[{"code":"7724111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone Lt Dist","code_information":[{"code":"7724112","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":3689.0,"discounted_cash":1475.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Peg Bone Fixat 2X20Mm Lck Perm","code_information":[{"code":"7724113","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone Alians Ulna 3/3 3.5Mm Std 14Mm Lck Monoaxial Cortic Non-Anodized F/Ulnar Shortening","code_information":[{"code":"7724114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X12Mm Lck","code_information":[{"code":"7724115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X14Mm Lck Vt3.5L14","code_information":[{"code":"7724116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Wire Bone Fixat 1.2X100Mm Kirschner Temp","code_information":[{"code":"7724117","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4.5X36Mm Cannul Partial Thread Lo-Pro Cortic Ti T15 Hexalobe Drive Black Wrist Hand","code_information":[{"code":"7724118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 6.7X75Mm Cannul 18Mm Partial Thread Self-Drilling/Tapping Lo-Pro Cancell Ti Clavicle","code_information":[{"code":"7724119","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 6.7X65Mm Cannul 18Mm Partial Thread Self-Drilling/Tapping Lo-Pro Cancell Ti Clavicle","code_information":[{"code":"7724120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Augment Femur P.F.C Sigma Size 3 8Mm Wedge/Block Lt Dist Knee Strl Disp","code_information":[{"code":"7724121","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2565.0,"discounted_cash":1026.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bowl Mix Container F/Cemex System Strl Disp","code_information":[{"code":"7724122","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"System Bone Cement Cemex 28Ml Low Viscos Pmma 80Gm Polymer Strl","code_information":[{"code":"7724123","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":236.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Component Femur Optetrak Logic Size 2.5 Cement Cylindr Post Stabil Rt","code_information":[{"code":"7724124","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":19932.0,"discounted_cash":7972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Tray Tibial Optetrak Logic Size 2.5F/1.5T Cement Finned Fit Knee Strl","code_information":[{"code":"7724125","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":10157.0,"discounted_cash":4062.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Optetrak Logic Size 2.5 9Mm Modul Post Stabil Pe","code_information":[{"code":"7724126","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6483.0,"discounted_cash":2593.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Plate Bone A.L.P.S 109Mm 4-Hole Lck Timax Rt Dist Fibula Purple Ns","code_information":[{"code":"7724127","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":1759.0,"discounted_cash":703.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Baseplate Tibial Size 4 Cement Unicompart High Flexion Tivanium Lt Medial Rt Lat","code_information":[{"code":"7724128","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":6013.0,"discounted_cash":2405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Liner Tibial Zuk Size 4 8Mm Net-Shaped Artic Surface Unicompart High Flexion Mold Uhmwpe Strl","code_information":[{"code":"7724129","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1015.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Kit Catheter Picc Bioflo Mst 6Frx55Cm 3Lumen Revers Taper Pasv Vlv Power Inject Trim W/70Cm Nt Ptfe","code_information":[{"code":"7724130","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.0,"discounted_cash":194.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 3.5X10Mm Non-Locking Full Thread Self-Drill Lo-Pro Cortic Ss T15 Hexalobe Drive Clavicle","code_information":[{"code":"7724131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 3.5X12Mm Non-Locking Full Thread Self-Drill Lo-Pro Cortic Ss T15 Hexalobe Drive Clavicle","code_information":[{"code":"7724132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Screw Bone 4X14Mm Non-Locking Full Thread Self-Drill Lo-Pro Cancell Ss T15 Hexalobe Drive Clavicle","code_information":[{"code":"7724133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Screw Bone 4X16Mm Non-Locking Full Thread Self-Drill Lo-Pro Cancell Ss T15 Hexalobe Drive Clavicle","code_information":[{"code":"7724134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule"}]},{"description":"Bit Drill Arthro 2.5X42Mm Ankle Cannul Ao Shaft Calib Grad Lf Strl Disp F/2.7/3Mm Screw Frx Manage","code_information":[{"code":"7724135","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base Price Schedule | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Cage Spinal Roi-A Median 30X39X12Mm Tantalum Marker Peek-Optima Lt1 Ant Lumb 10Deg Lordot Yellow","code_information":[{"code":"7724136","type":"CDM"},{"code":"278","type":"RC"}],"standard_charges":[{"gross_charge":14618.0,"discounted_cash":5847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Base P